Provider Demographics
NPI:1861925935
Name:COL 323 PROFESSIONAL SERVICES, LLC
Entity type:Organization
Organization Name:COL 323 PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-244-5153
Mailing Address - Street 1:5335 98TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-4437
Mailing Address - Country:US
Mailing Address - Phone:813-244-5153
Mailing Address - Fax:727-245-8442
Practice Address - Street 1:5335 98TH AVE E
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-4437
Practice Address - Country:US
Practice Address - Phone:813-244-5153
Practice Address - Fax:727-245-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies