Provider Demographics
NPI:1972069995
Name:FRONT RANGE PAIN MEDICINE LLC
Entity type:Organization
Organization Name:FRONT RANGE PAIN MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GIRARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-495-0506
Mailing Address - Street 1:3744 S TIMBERLINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4334
Mailing Address - Country:US
Mailing Address - Phone:970-495-0506
Mailing Address - Fax:
Practice Address - Street 1:1605 FOXTRAIL DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9360
Practice Address - Country:US
Practice Address - Phone:970-495-0506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT RANGE PAIN MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-14
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty