Provider Demographics
NPI:1679996854
Name:PROMEDIUS LTD
Entity type:Organization
Organization Name:PROMEDIUS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAJENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:719-510-3135
Mailing Address - Street 1:417 CHARLOTTE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-8636
Mailing Address - Country:US
Mailing Address - Phone:970-587-9978
Mailing Address - Fax:970-587-9980
Practice Address - Street 1:417 CHATLOTTE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-8636
Practice Address - Country:US
Practice Address - Phone:970-587-9978
Practice Address - Fax:970-587-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment