Provider Demographics
NPI:1134614936
Name:LIBERTY PAIN INSTITUTE
Entity type:Organization
Organization Name:LIBERTY PAIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-219-2320
Mailing Address - Street 1:2020 N ACADEMY BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1569
Mailing Address - Country:US
Mailing Address - Phone:719-219-2320
Mailing Address - Fax:719-231-2321
Practice Address - Street 1:2020 N ACADEMY BLVD STE 155
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1569
Practice Address - Country:US
Practice Address - Phone:719-219-2320
Practice Address - Fax:719-231-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0056860261QP2300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care