Provider Demographics
NPI:1053033340
Name:COLORADO PAIN RELIEF OF COLORADO SPRINGS INC
Entity type:Organization
Organization Name:COLORADO PAIN RELIEF OF COLORADO SPRINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-525-8577
Mailing Address - Street 1:1304 N ACADEMY BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3318
Mailing Address - Country:US
Mailing Address - Phone:719-488-1315
Mailing Address - Fax:
Practice Address - Street 1:1304 N ACADEMY BLVD STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-488-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO PAIN RELIEF OF COLORADO SPRINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176409Medicaid