Provider Demographics
NPI:1649786146
Name:MEDICAL EQUIPMENT SUPPLIER
Entity type:Organization
Organization Name:MEDICAL EQUIPMENT SUPPLIER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CITIZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-437-3213
Mailing Address - Street 1:1642 S PARKER RD STE 211
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2916
Mailing Address - Country:US
Mailing Address - Phone:303-437-3213
Mailing Address - Fax:
Practice Address - Street 1:1642 S PARKER RD STE 211
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2916
Practice Address - Country:US
Practice Address - Phone:303-437-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies