Provider Demographics
NPI:1619448842
Name:PHYSICIAN PAIN CONSULTANTS. LLC.
Entity Type:Organization
Organization Name:PHYSICIAN PAIN CONSULTANTS. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-459-2874
Mailing Address - Street 1:3330 S BROADWAY UNIT 11007
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2428
Mailing Address - Country:US
Mailing Address - Phone:720-459-2874
Mailing Address - Fax:303-422-6683
Practice Address - Street 1:3330 S BROADWAY UNIT 11007
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2428
Practice Address - Country:US
Practice Address - Phone:720-459-2874
Practice Address - Fax:303-422-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain