Provider Demographics
NPI:1568147270
Name:COLORADO PAIN PRACTICE, PLLC
Entity Type:Organization
Organization Name:COLORADO PAIN PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-756-3245
Mailing Address - Street 1:2696 S COLORADO BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5948
Mailing Address - Country:US
Mailing Address - Phone:303-468-7246
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:4348 WOODLANDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2815
Practice Address - Country:US
Practice Address - Phone:303-468-7246
Practice Address - Fax:303-277-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty