Basic Information
| Provider Information | |||||||||
| NPI: | 1306131073 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METRO DENVER PAIN MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 GRANT ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037508100 | ||||||||
| FaxNumber: | 3033691891 | ||||||||
| Practice Location | |||||||||
| Address1: | 6950 E BELLEVIEW AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037508100 | ||||||||
| FaxNumber: | 3033691891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2011 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRIMARY PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3037508100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | 37926 | CO | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.