Provider Demographics
NPI:1326234691
Name:CENTENNIAL ANESTHESIA AND PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:CENTENNIAL ANESTHESIA AND PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMASCHEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-252-4590
Mailing Address - Street 1:15728 E PRENTICE LN
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4263
Mailing Address - Country:US
Mailing Address - Phone:720-252-4590
Mailing Address - Fax:
Practice Address - Street 1:15728 E PRENTICE LN
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4263
Practice Address - Country:US
Practice Address - Phone:720-252-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty