Provider Demographics
NPI:1376092890
Name:HEALTHDYNE SPECIALTY COLORADO, LLC
Entity type:Organization
Organization Name:HEALTHDYNE SPECIALTY COLORADO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:P
Authorized Official - Last Name:BISESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-583-6248
Mailing Address - Street 1:500 EAGLES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2899
Mailing Address - Country:US
Mailing Address - Phone:888-479-2000
Mailing Address - Fax:
Practice Address - Street 1:7472 S TUCSON WAY
Practice Address - Street 2:STE 100A
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4452
Practice Address - Country:US
Practice Address - Phone:800-641-8475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
COPDO16800001233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy