Healthcare Provider Details

I. General information

NPI: 1992039721
Provider Name (Legal Business Name): PAIN CARE CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2009
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 HOLLOW BROOK DR SUITE 110
COLORADO SPRINGS CO
80918-1452
US

IV. Provider business mailing address

2140 HOLLOW BROOK DR SUITE 110
COLORADO SPRINGS CO
80918-1452
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-3636
  • Fax: 719-434-3639
Mailing address:
  • Phone: 719-434-3636
  • Fax: 719-434-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E LAFAYETTE
Title or Position: PRESIDENT
Credential: FNP
Phone: 719-434-3636