Organization
AVICENNA MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSTISLAV VAISMAN (PRESIDENT)
(303) 388-7114
Entity
Organization
Contact information
Practice address
4045 WADSWORTH BLVD, UNIT # 308, WHEAT RIDGE, CO 80033-4642
(303) 388-7114
Mailing address
4045 WADSWORTH BLVD, UNIT # 308, WHEAT RIDGE, CO 80033-4642
(303) 388-7114
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
CO
Other
Enumeration date
10/27/2009
Last updated
07/21/2022
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