Provider Demographics
NPI:1306239009
Name:FORT COLLINS SPINE LLC DME
Entity type:Organization
Organization Name:FORT COLLINS SPINE LLC DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-440-0363
Mailing Address - Street 1:2021 BATTLECREEK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-5119
Mailing Address - Country:US
Mailing Address - Phone:505-440-0363
Mailing Address - Fax:
Practice Address - Street 1:2021 BATTLECREEK DR
Practice Address - Street 2:SUITE D
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-5119
Practice Address - Country:US
Practice Address - Phone:505-440-0363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT COLLINS SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies