1982746517 NPI number — FRONT RANGE PAIN SPECIALISTS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982746517 NPI number — FRONT RANGE PAIN SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONT RANGE PAIN SPECIALISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. STEPHEN M. FORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982746517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80936-6627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-579-9131
Provider Business Mailing Address Fax Number:
719-268-1766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1615 MEDICAL CENTER PT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-5788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-579-9131
Provider Business Practice Location Address Fax Number:
719-268-1766
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
ANESTHESIOLOGIST PAIN MANAGEMENT
Authorized Official Telephone Number:
719-579-9131

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  34354 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80918A002 . This is a "TRIWEST WPS GROUP NBR" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: DB8061 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01343540 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00129307 . This is a "RR MEDICARE ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: FOF39070 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 71138731 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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