Provider Demographics
NPI:1710956735
Name:COLORADO PAIN SPECIALISTS PC
Entity Type:Organization
Organization Name:COLORADO PAIN SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-268-4040
Mailing Address - Street 1:3600 S YOSEMITE ST
Mailing Address - Street 2:STE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1812
Mailing Address - Country:US
Mailing Address - Phone:303-268-4040
Mailing Address - Fax:303-736-4147
Practice Address - Street 1:325 S TELLER ST
Practice Address - Street 2:SUITE 240
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7388
Practice Address - Country:US
Practice Address - Phone:303-268-4040
Practice Address - Fax:303-736-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802448OtherMEDICARE ID-PIN
CO665046OtherBLUE CROSS BLUE SHIELD
COC802448OtherMEDICARE ID-PIN