Provider Demographics
NPI:1790847705
Name:COLORADO INSTITUTE FOR NEUROMUSCULAR AND NEUROLOGICAL DISORDERS, PLLC
Entity Type:Organization
Organization Name:COLORADO INSTITUTE FOR NEUROMUSCULAR AND NEUROLOGICAL DISORDERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAVOT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-485-3535
Mailing Address - Street 1:600 S AIRPORT RD
Mailing Address - Street 2:SUITE E, BLDG. B
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6424
Mailing Address - Country:US
Mailing Address - Phone:720-491-3322
Mailing Address - Fax:720-684-6715
Practice Address - Street 1:600 S AIRPORT RD
Practice Address - Street 2:SUITE E, BLDG. B
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6424
Practice Address - Country:US
Practice Address - Phone:720-491-3322
Practice Address - Fax:720-684-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO412612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02306719Medicaid
COH39024Medicare UPIN
CO02306719Medicaid