Healthcare Provider Details

I. General information

NPI: 1720160229
Provider Name (Legal Business Name): PAIN PARTNERS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 EMPIRE ROAD SUITE 200
LAFAYETTE CO
80026
US

IV. Provider business mailing address

380 EMPIRE ROAD SUITE 200
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 303-926-7360
  • Fax: 303-926-7359
Mailing address:
  • Phone: 303-926-7360
  • Fax: 303-926-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number42618
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberCO42618
License Number StateCO

VIII. Authorized Official

Name: DR. SCOTT T BOYD
Title or Position: CEO
Credential: MD
Phone: 303-926-7360