Provider Demographics
NPI:1407132244
Name:LONGS PEAK PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:LONGS PEAK PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:E. JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-290-5056
Mailing Address - Street 1:5285 MCWHINNEY BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5285 MCWHINNEY BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8863
Practice Address - Country:US
Practice Address - Phone:970-290-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty