Provider Demographics
NPI:1770771289
Name:COLORADO SPINE AND PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:COLORADO SPINE AND PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AL TAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-248-7220
Mailing Address - Street 1:7720 S BROADWAY
Mailing Address - Street 2:SUITE 590
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2632
Mailing Address - Country:US
Mailing Address - Phone:303-248-7220
Mailing Address - Fax:303-248-7221
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:SUITE 590
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2632
Practice Address - Country:US
Practice Address - Phone:303-248-7220
Practice Address - Fax:303-248-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44358208VP0000X, 207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811535Medicare PIN