Provider Demographics
NPI:1063799013
Name:MOUNTAIN MEDICAL INJURAY AND PAIN PROFESSIONAL
Entity type:Organization
Organization Name:MOUNTAIN MEDICAL INJURAY AND PAIN PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-521-7395
Mailing Address - Street 1:5534 SALVIA CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1118
Mailing Address - Country:US
Mailing Address - Phone:303-886-4300
Mailing Address - Fax:
Practice Address - Street 1:5534 SALVIA CT
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1118
Practice Address - Country:US
Practice Address - Phone:303-886-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty