Provider Demographics
NPI:1326877887
Name:OBSIDIAN MEDICAL LLC
Entity type:Organization
Organization Name:OBSIDIAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JIRON
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:970-201-3721
Mailing Address - Street 1:2887 JEAN LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-4826
Mailing Address - Country:US
Mailing Address - Phone:970-201-3721
Mailing Address - Fax:
Practice Address - Street 1:3096 I-70 BUSINESS LOOP UNIT E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4419
Practice Address - Country:US
Practice Address - Phone:970-201-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition