Organization
COLORADO STATE INFUSION, INC.
Active
Other names
COLORADO STATE INFUSION INC
Organization subpart
No
Provider details
NPI number
Authorized official
JOE BRAYTON (CHIEF STRATEGY OFFICER/EVP)
(972) 588-1050
Entity
Organization
Contact information
Practice address
1401 N 1ST ST, GRAND JUNCTION, CO 81501-2115
(970) 243-3411
(970) 243-3364
Mailing address
17111 PRESTON RD, SUITE 100, DALLAS, TX 75248-1229
(866) 972-5888
(866) 491-5888
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PDO.0530000052
CO
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003295
PK
—
05
—
84152877
—
CO
01
—
PDO.0530000052
DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
02/08/2007
Last updated
11/03/2020
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