Provider Demographics
NPI:1912941253
Name:CLOUD CITY MEDICAL
Entity type:Organization
Organization Name:CLOUD CITY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-486-2950
Mailing Address - Street 1:735 US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3952
Mailing Address - Country:US
Mailing Address - Phone:719-486-2950
Mailing Address - Fax:719-486-2959
Practice Address - Street 1:735 US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3952
Practice Address - Country:US
Practice Address - Phone:719-486-2950
Practice Address - Fax:719-486-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07688730000332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21588856Medicaid
CO4500990005Medicare ID - Type Unspecified
CA4500990001Medicare ID - Type UnspecifiedPROVIDER NUMBER