Provider Demographics
NPI:1699300376
Name:COLORADO PAIN PRACTICE, LLC
Entity type:Organization
Organization Name:COLORADO PAIN PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MOGHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-888-2219
Mailing Address - Street 1:1355 S COLORADO BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3325
Mailing Address - Country:US
Mailing Address - Phone:303-277-0700
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:4348 WOODLANDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2815
Practice Address - Country:US
Practice Address - Phone:303-468-7246
Practice Address - Fax:303-277-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty