Provider Demographics
NPI:1053461921
Name:E.A.S.E. MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:E.A.S.E. MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-276-1703
Mailing Address - Street 1:380 SKYLAND DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:PENROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81240-9524
Mailing Address - Country:US
Mailing Address - Phone:719-276-1703
Mailing Address - Fax:719-276-1708
Practice Address - Street 1:380 SKYLAND DRIVE
Practice Address - Street 2:STE A
Practice Address - City:PENROSE
Practice Address - State:CO
Practice Address - Zip Code:81240-9524
Practice Address - Country:US
Practice Address - Phone:719-276-1703
Practice Address - Fax:719-276-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26-45304-0000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87385015Medicaid
CO5246170001Medicare NSC