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General NPI Number Information
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NPI Number | 1447643127
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Entity Type | Organization
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Legal Business Name | COLORADO INSTITUTE FOR PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 3910 S CAREFREE CIR STE C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-3053
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Country | US
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Telephone | 719-599-5753
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Fax | 719-599-5817
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Provider Business Mailing Address
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Address Line | 3910 S CAREFREE CIR STE C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-3053
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Country | US
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Telephone | 719-599-5753
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Fax | 719-599-5817
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN MASON TYLER JR.
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Credential | M.D.
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Telephone | 719-599-5753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 30232
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 30232
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License Number State | CO
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