Provider Demographics
NPI:1356493548
Name:PAIN CENTER OF THE ROCKIES
Entity Type:Organization
Organization Name:PAIN CENTER OF THE ROCKIES
Other - Org Name:ORTHOPEDIC PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-1919
Mailing Address - Street 1:2001 S SHIELDS BLDG L
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-221-1919
Mailing Address - Fax:970-493-6643
Practice Address - Street 1:3810 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-669-8881
Practice Address - Fax:970-669-4200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN ASSOCIATES IN ORTHOPEDIC MEDICINE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01171958Medicaid
COD23215Medicare UPIN
CO01171958Medicaid