Provider Demographics
NPI:1124566955
Name:DENVER DIAGNOSTIC PAIN CORPORATION
Entity Type:Organization
Organization Name:DENVER DIAGNOSTIC PAIN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-801-8414
Mailing Address - Street 1:7800 E ORCHARD RD
Mailing Address - Street 2:STE 350
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2583
Mailing Address - Country:US
Mailing Address - Phone:720-598-0805
Mailing Address - Fax:720-606-2905
Practice Address - Street 1:13402 W COAL MINE AVE
Practice Address - Street 2:STE240
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5407
Practice Address - Country:US
Practice Address - Phone:720-598-0805
Practice Address - Fax:720-606-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51092207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83325778Medicaid