MEDICARE: ADVANCED PAIN MANAGEMENT

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	174400000X	Specialist	36737	CO

General Provider Information

NPI Number	:	1588715510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-591-0007
Fax Number	:	719-260-9799

Provider Business Practice Location Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-591-0007
Fax Number	:	719-260-9799

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JOHN W NELSON
Credential	:	M.D.
Telephone Number	:	719-785-1161

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	06/16/2008

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Directions to “ADVANCED PAIN MANAGEMENT ” Practice Location

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