Healthcare Provider Details

I. General information

NPI: 1689189714
Provider Name (Legal Business Name): PRIMUS INTEGRATED MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 NORTHGATE DR UNIT 130
PARKER CO
80134-5778
US

IV. Provider business mailing address

16830 NORTHGATE DR UNIT 130
PARKER CO
80134-5778
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-7246
  • Fax:
Mailing address:
  • Phone: 303-805-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: REID M CHRISTOPHERSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 719-351-1604