=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215219613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENVER PAIN RELIEF CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 12/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 E HAMPDEN AVE SUITE 500
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-3781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-789-5242
-----------------------------------------------------
Fax | 303-789-5264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 E HAMPDEN AVE SUITE 500
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-3781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-789-5242
-----------------------------------------------------
Fax | 303-789-5264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | WILLIAM MILO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-569-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------