Healthcare Provider Details

I. General information

NPI: 1770771289
Provider Name (Legal Business Name): COLORADO SPINE AND PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 S BROADWAY SUITE 590
LITTLETON CO
80122-2632
US

IV. Provider business mailing address

7720 S BROADWAY SUITE 590
LITTLETON CO
80122-2632
US

V. Phone/Fax

Practice location:
  • Phone: 303-248-7220
  • Fax: 303-248-7221
Mailing address:
  • Phone: 303-248-7220
  • Fax: 303-248-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number44358
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44358
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number44358
License Number StateCO

VIII. Authorized Official

Name: DR. MAZIN AL TAMIMI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-248-7220