Healthcare Provider Details

I. General information

NPI: 1568980811
Provider Name (Legal Business Name): COLORADO HEALTH PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 15TH AVE STE 104
LONGMONT CO
80501-2764
US

IV. Provider business mailing address

PO BOX 889
LOVELAND CO
80539-0889
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-9451
  • Fax: 877-535-9359
Mailing address:
  • Phone: 970-221-9451
  • Fax: 877-535-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID C FEEBACK
Title or Position: OWNER
Credential: CEO
Phone: 970-221-9451