Provider Demographics
NPI:1477924728
Name:THE BRAIN CENTER OF COLORADO
Entity Type:Organization
Organization Name:THE BRAIN CENTER OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIRL
Authorized Official - Suffix:JR
Authorized Official - Credentials:CHT
Authorized Official - Phone:719-452-9808
Mailing Address - Street 1:322 MISSION HILL WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3238
Mailing Address - Country:US
Mailing Address - Phone:719-452-9808
Mailing Address - Fax:
Practice Address - Street 1:404 JERRY ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2468
Practice Address - Country:US
Practice Address - Phone:719-452-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0013119302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization