Provider Demographics
NPI:1790737856
Name:FRONT RANGE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:FRONT RANGE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALDON
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANDES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-348-0090
Mailing Address - Street 1:1175 58TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4807
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:STE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4816
Practice Address - Country:US
Practice Address - Phone:970-348-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41081207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COFR674273OtherANTHEM BCBS
CO42588529Medicaid
CODD8492OtherRAILROAD MEDICARE
CODD8492OtherRAILROAD MEDICARE
COC803338Medicare PIN