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NPI Code Detail

MEDICARE: FRONT RANGE PAIN MEDICINE

MEDICARE: FRONT RANGE PAIN MEDICINE
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
1207LP2900XPain Medicine (Anesthesiology) Physician28646CO

General Provider Information

NPI Number : 1992823645
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRONT RANGE PAIN MEDICINE
Provider Business Mailing Address
First Line : 709 BOULDER CIR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-9252
Country : US
Telephone Number : 970-498-0511
Fax Number : 970-484-4514
Provider Business Practice Location Address
First Line : 3744 S TIMBERLINE RD
Second Line : SUITE 102
City : FORT COLLINS
State : CO
Zip : 80525-4333
Country : US
Telephone Number : 970-495-0506
Fax Number : 970-484-4514
Authorized Official
Title or Position : OWNER
Name : DR. THOMAS BOYLAN
Credential : DO
Telephone Number : 970-495-0506
Provider Enumeration Date : 03/27/2007
Last Update Date : 08/22/2020

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Directions to “FRONT RANGE PAIN MEDICINE ” Practice Location

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