Healthcare Provider Details

I. General information

NPI: 1285679829
Provider Name (Legal Business Name): COLORADO PAIN AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 W 38TH AVE
WHEAT RIDGE CO
80033-6109
US

IV. Provider business mailing address

PO BOX 271410
LITTLETON CO
80127-0024
US

V. Phone/Fax

Practice location:
  • Phone: 303-423-8334
  • Fax: 303-456-1856
Mailing address:
  • Phone: 303-423-8334
  • Fax: 303-456-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0000000000
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18859020
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: FREDRIC ZIMMERMAN
Title or Position: OWNER
Credential:
Phone: 303-423-8334