Provider Demographics
NPI:1285767772
Name:PLATINUM MEDICAL LLC
Entity type:Organization
Organization Name:PLATINUM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-777-3788
Mailing Address - Street 1:PO BOX 100130
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80250-0130
Mailing Address - Country:US
Mailing Address - Phone:303-777-3788
Mailing Address - Fax:303-777-3788
Practice Address - Street 1:2758 S KNOXVILLE WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3858
Practice Address - Country:US
Practice Address - Phone:303-777-3788
Practice Address - Fax:303-940-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2006-23416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10025480400OtherNE MEDICAID
CO88624382Medicaid
COC803170Medicare PIN