Provider Demographics
NPI:1831238161
Name:COLORADO PAIN MANAGEMENT &
Entity type:Organization
Organization Name:COLORADO PAIN MANAGEMENT &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:N
Authorized Official - Last Name:REUSSWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-422-7991
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80001-0467
Mailing Address - Country:US
Mailing Address - Phone:303-422-7991
Mailing Address - Fax:303-422-7994
Practice Address - Street 1:8451 PEARL ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4804
Practice Address - Country:US
Practice Address - Phone:303-227-6367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57488045Medicaid
CO57488045Medicaid