Basic Information
| Provider Information | |||||||||
| NPI: | 1790437978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO PAIN EXPERTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20280 N 59TH AVE STE 115-617 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853086850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704737900 | ||||||||
| FaxNumber: | 9704737902 | ||||||||
| Practice Location | |||||||||
| Address1: | 1647 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805384209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704737900 | ||||||||
| FaxNumber: | 9704737902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2022 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 6027958700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.