Healthcare Provider Details

I. General information

NPI: 1346852613
Provider Name (Legal Business Name): ROCKY MOUNTAIN PAIN PRIMARY ARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 N ACADEMY BLVD STE 206
COLORADO SPRINGS CO
80909-3318
US

IV. Provider business mailing address

1304 N ACADEMY BLVD STE 206
COLORADO SPRINGS CO
80909-3318
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-4073
  • Fax: 719-596-4130
Mailing address:
  • Phone: 719-596-4073
  • Fax: 719-596-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS JOSEPH
Title or Position: PROVIDER
Credential: MD
Phone: 773-678-7595