Healthcare Provider Details

I. General information

NPI: 1194537910
Provider Name (Legal Business Name): PROHEALTH PAIN MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 E TUFTS AVE STE 510
DENVER CO
80237-2580
US

IV. Provider business mailing address

8181 E TUFTS AVE STE 510
DENVER CO
80237-2580
US

V. Phone/Fax

Practice location:
  • Phone: 866-782-8393
  • Fax:
Mailing address:
  • Phone: 866-782-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PRADEEP R RAI
Title or Position: OWNER
Credential: MD
Phone: 866-782-8393