Provider Demographics
NPI:1639367493
Name:BOULDER PAIN INSTITUTE, PC
Entity Type:Organization
Organization Name:BOULDER PAIN INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-413-0100
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3573
Mailing Address - Country:US
Mailing Address - Phone:303-413-0100
Mailing Address - Fax:
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-413-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty