Provider Demographics
NPI:1104357581
Name:COLORADO HEALTH PROVIDERS, LLC
Entity Type:Organization
Organization Name:COLORADO HEALTH PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-9451
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-0889
Mailing Address - Country:US
Mailing Address - Phone:970-221-9451
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST STE 320
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5448
Practice Address - Country:US
Practice Address - Phone:970-221-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
479362Medicare PIN