Healthcare Provider Details

I. General information

NPI: 1043995715
Provider Name (Legal Business Name): COLORADO PAIN PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12596 W BAYAUD AVE STE 350
LAKEWOOD CO
80228-2019
US

IV. Provider business mailing address

2696 S COLORADO BLVD STE 240
DENVER CO
80222-5948
US

V. Phone/Fax

Practice location:
  • Phone: 303-468-7246
  • Fax: 303-277-0714
Mailing address:
  • Phone: 303-756-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LAWRENCE MITCHELL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 303-756-3245