MEDICARE: H.R. PAIN MANAGEMENT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	28210	CO
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	28210	CO
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	28210	CO
4	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	28210	CO
5	2083S0010X	Sports Medicine (Preventive Medicine) Physician	28210	CO
6	2083X0100X	Occupational Medicine Physician	28210	CO
7	208VP0000X	Pain Medicine Physician	28210
8	208VP0014X	Interventional Pain Medicine Physician	28210	CO
9	208100000X	Physical Medicine & Rehabilitation Physician	28210	CO

General Provider Information

NPI Number	:	1306995196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.R. PAIN MANAGEMENT INC.

Provider Business Mailing Address
First Line	:	3220 W 62ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-1907
Country	:	US
Telephone Number	:	303-494-7052
Fax Number	:	303-635-1225

Provider Business Practice Location Address
First Line	:	7695 CHURCH RANCH BLVD
Second Line	:	SUITE 100
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-5544
Country	:	US
Telephone Number	:	303-494-7052
Fax Number	:	303-635-1225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHANE RYAN KOKOSZKA
Credential	:
Telephone Number	:	303-494-7052

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/16/2021

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