Provider Demographics
NPI:1588629927
Name:COLORADO REHABILITATION AND OCCUPATIONAL MEDICINE, PLLC
Entity type:Organization
Organization Name:COLORADO REHABILITATION AND OCCUPATIONAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:TASHOF
Authorized Official - Last Name:BERNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-341-0722
Mailing Address - Street 1:1390 S POTOMAC ST
Mailing Address - Street 2:STE 128
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6165
Mailing Address - Country:US
Mailing Address - Phone:303-341-4785
Mailing Address - Fax:303-341-1479
Practice Address - Street 1:1390 S POTOMAC ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6165
Practice Address - Country:US
Practice Address - Phone:303-341-0722
Practice Address - Fax:303-341-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010666Medicaid
COCL0508Medicare PIN