Healthcare Provider Details

I. General information

NPI: 1275338501
Provider Name (Legal Business Name): PAM PHYSICIAN ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 W 40TH AVE
GOLDEN CO
80401-2696
US

IV. Provider business mailing address

PO BOX 206478
DALLAS TX
75320-6478
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MISITANO
Title or Position: PRESIDENT
Credential:
Phone: 717-731-9660