Provider Demographics
NPI:1710927512
Name:ADVANCED PAIN AND ANESTHESIA SERVICES PC
Entity Type:Organization
Organization Name:ADVANCED PAIN AND ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMASHEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-755-2900
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 057
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:700 POTOMAC ST
Practice Address - Street 2:MEDICAL CENTER OF AURORA NORTH
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6701
Practice Address - Country:US
Practice Address - Phone:303-755-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80159575Medicaid
COAD671857OtherBLUE SHIELD
CO801358Medicare ID - Type Unspecified