Provider Demographics
NPI:1003864398
Name:CENTENO-SCHULTZ, INC
Entity Type:Organization
Organization Name:CENTENO-SCHULTZ, INC
Other - Org Name:CENTENO SCHULTZ CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEASER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:303-468-1152
Mailing Address - Street 1:403 SUMMIT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021
Mailing Address - Country:US
Mailing Address - Phone:303-429-6448
Mailing Address - Fax:303-951-3701
Practice Address - Street 1:403 SUMMIT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-429-6448
Practice Address - Fax:303-951-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33826207LP2900X
CO32265208VP0014X
208VP0014X
CO1528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE73265Medicare UPIN
CO803964Medicare ID - Type UnspecifiedJOHN SCHULTZ
CO803963Medicare ID - Type UnspecifiedCHRISTOPHER CENTENO
CO803962Medicare ID - Type UnspecifiedMARK REILLY
CO803965Medicare ID - Type UnspecifiedSHANNON BOCK
COF30181Medicare UPIN
COC803961Medicare PIN
COQ37780Medicare UPIN