MEDICARE: COLORADO PAIN SPECIALISTS PC

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	208VP0014X	Interventional Pain Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C802448	OTHER	CO	MEDICARE ID-PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	665046	OTHER	CO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1710956735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PAIN SPECIALISTS PC

Provider Business Mailing Address
First Line	:	3600 S YOSEMITE ST
Second Line	:	STE 330
City	:	DENVER
State	:	CO
Zip	:	80237-1812
Country	:	US
Telephone Number	:	303-268-4040
Fax Number	:	303-736-4147

Provider Business Practice Location Address
First Line	:	325 S TELLER ST
Second Line	:	SUITE 240
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-7388
Country	:	US
Telephone Number	:	303-268-4040
Fax Number	:	303-736-4147

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. BRADLEY D VILIMS
Credential	:	MD
Telephone Number	:	303-268-4040

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/03/2007

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Directions to “COLORADO PAIN SPECIALISTS PC ” Practice Location

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