Provider Demographics
NPI:1699423921
Name:RIVERS EDGE PAIN SPECIALISTS PLLC
Entity type:Organization
Organization Name:RIVERS EDGE PAIN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JANAE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, NP-C
Authorized Official - Phone:970-778-6323
Mailing Address - Street 1:2033 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-9710
Mailing Address - Country:US
Mailing Address - Phone:970-314-7094
Mailing Address - Fax:970-314-7094
Practice Address - Street 1:2249 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1157
Practice Address - Country:US
Practice Address - Phone:970-314-7094
Practice Address - Fax:970-314-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty