Provider Demographics
NPI:1740059401
Name:COLORADO PAIN PRACTICE, PLLC
Entity type:Organization
Organization Name:COLORADO PAIN PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-468-7246
Mailing Address - Street 1:2696 S COLORADO BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5948
Mailing Address - Country:US
Mailing Address - Phone:303-468-7246
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:1647 E 18TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4209
Practice Address - Country:US
Practice Address - Phone:970-473-7900
Practice Address - Fax:970-473-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty