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General NPI Number Information
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NPI Number | 1326234691
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Entity Type | Organization
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Legal Business Name | CENTENNIAL ANESTHESIA AND PAIN MANAGEMENT PLLC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15728 E PRENTICE LN
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City | CENTENNIAL
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State | CO
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Zip | 80015-4263
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Country | US
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Telephone | 720-252-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 15728 E PRENTICE LN
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City | CENTENNIAL
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State | CO
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Zip | 80015-4263
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Country | US
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Telephone | 720-252-4590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VITALIY DOMASCHEVICH
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Credential | MD
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Telephone | 720-252-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | CO
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