Provider Demographics
NPI:1336446475
Name:CRANIOFACIAL PAIN AND SLEEP CENTER
Entity type:Organization
Organization Name:CRANIOFACIAL PAIN AND SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MPS
Authorized Official - Phone:970-484-0250
Mailing Address - Street 1:2627 REDWING RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6321
Mailing Address - Country:US
Mailing Address - Phone:970-484-0250
Mailing Address - Fax:970-484-1522
Practice Address - Street 1:2627 REDWING RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6321
Practice Address - Country:US
Practice Address - Phone:970-484-0250
Practice Address - Fax:970-484-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6496760001Medicare NSC