Provider Demographics
NPI:1821175100
Name:MARK C MEYER MD LLC
Entity Type:Organization
Organization Name:MARK C MEYER MD LLC
Other - Org Name:SPINAL DIAGNOSTICS & PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-448-0981
Mailing Address - Street 1:5901 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1941
Mailing Address - Country:US
Mailing Address - Phone:719-598-7562
Mailing Address - Fax:719-598-2775
Practice Address - Street 1:5901 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1941
Practice Address - Country:US
Practice Address - Phone:719-598-7562
Practice Address - Fax:719-598-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10403617OtherCAQH PROVIDER NUMBER
CO01352509Medicaid
CO35250OtherCOLORADO LICENSE
COBM3322459OtherDEA NUMBER
CO01352509Medicaid
CO10403617OtherCAQH PROVIDER NUMBER