Organization
ETAIL MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK ALAN DEZENGREMEL II (CO CEO/PRESIDENT)
(303) 884-1935
Entity
Organization
Contact information
Practice address
5156 RIALTO DR, PARKER, CO 80134-5234
(303) 667-5929
(303) 379-3775
Mailing address
5156 RIALTO DR, PARKER, CO 80134-5234
(303) 379-3775
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
20091385108
CO
Other
Enumeration date
11/05/2009
Last updated
11/05/2009
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