Provider Demographics
NPI:1588787469
Name:COLORADO OSTEOPATHIC & INTEGRATIVE MEDICINE ASSOCIATES, PC
Entity type:Organization
Organization Name:COLORADO OSTEOPATHIC & INTEGRATIVE MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAUTHRON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-781-7862
Mailing Address - Street 1:4901 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2025
Mailing Address - Country:US
Mailing Address - Phone:303-781-7862
Mailing Address - Fax:303-781-7864
Practice Address - Street 1:4901 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2025
Practice Address - Country:US
Practice Address - Phone:303-781-7862
Practice Address - Fax:303-781-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO415232081P2900X
204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805150Medicare PIN