Organization
BILLING&CODING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA DENICE JACKSON (OWNER)
(719) 821-8222
Entity
Organization
Contact information
Practice address
3410 COCHRAN DR APT C, COLORADO SPRINGS, CO 80916-3550
(719) 821-8222
Mailing address
3410 COCHRAN DR APT C, COLORADO SPRINGS, CO 80916-3550
(719) 821-8222
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/01/2014
Last updated
02/01/2014
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