Provider Demographics
NPI:1659947034
Name:HOLISTIC PAIN MANAGEMENT OF COLORADO LLC
Entity Type:Organization
Organization Name:HOLISTIC PAIN MANAGEMENT OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISBY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:307-250-4953
Mailing Address - Street 1:3780 N GARFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2237
Mailing Address - Country:US
Mailing Address - Phone:800-928-6040
Mailing Address - Fax:833-923-2295
Practice Address - Street 1:111 6TH ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:CO
Practice Address - Zip Code:80821-2002
Practice Address - Country:US
Practice Address - Phone:719-743-2421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain