Provider Demographics
NPI:1699711937
Name:NORTHEAST COLORADO MEDICAL EQUIPMENT & SUPPLY LLC
Entity type:Organization
Organization Name:NORTHEAST COLORADO MEDICAL EQUIPMENT & SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:970-522-7188
Mailing Address - Street 1:402 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3302
Mailing Address - Country:US
Mailing Address - Phone:970-522-7188
Mailing Address - Fax:970-522-7194
Practice Address - Street 1:402 N 3RD ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3302
Practice Address - Country:US
Practice Address - Phone:970-522-7188
Practice Address - Fax:970-522-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30577365Medicaid
CO30577365Medicaid