Healthcare Provider Details

I. General information

NPI: 1003864398
Provider Name (Legal Business Name): CENTENO-SCHULTZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD SUITE 201
BROOMFIELD CO
80021
US

IV. Provider business mailing address

403 SUMMIT BLVD SUITE 201
BROOMFIELD CO
80021
US

V. Phone/Fax

Practice location:
  • Phone: 303-429-6448
  • Fax: 303-951-3701
Mailing address:
  • Phone: 303-429-6448
  • Fax: 303-951-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number33826
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number32265
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1528
License Number StateCO

VIII. Authorized Official

Name: CARL MEASER
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 303-468-1152