Provider Demographics
NPI:1306912910
Name:ELSHADAI MEDICAL SERVICES INC.
Entity type:Organization
Organization Name:ELSHADAI MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOMA
Authorized Official - Middle Name:ADELAIDE
Authorized Official - Last Name:FONGUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-755-5656
Mailing Address - Street 1:2620 S PARKER RD
Mailing Address - Street 2:SUITE # 150
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1608
Mailing Address - Country:US
Mailing Address - Phone:303-755-5656
Mailing Address - Fax:
Practice Address - Street 1:2620 S PARKER RD
Practice Address - Street 2:SUITE # 150
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1608
Practice Address - Country:US
Practice Address - Phone:303-755-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75521768332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75521768Medicaid