WIND RIVER PAIN MANAGEMENT, LLC


Address: 5873 Highland Hills Cir, Fort Collins, CO 80528-8941
Phone: 9704209904

WIND RIVER PAIN MANAGEMENT, LLC (NPI# 1104992296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104992296
Entity Type Organization
Organization Name WIND RIVER PAIN MANAGEMENT, LLC
Practice Address 5873 Highland Hills Cir
Fort Collins
CO 80528-8941
Practice Telephone 9704209904
Mailing Telephone 9704209904
Enumeration Date 2006-11-28
Last Update Date 2020-08-22
Authorized Official Name DR. JAMES ALAN DERRISAW (CEO)
Authorized Official Telephone 9704209904
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QP3300X Clinic/Center
Specialization: Pain
39525 CO Ambulatory Health Care Facilities

Office Location

Street Address 5873 HIGHLAND HILLS CIR
City FORT COLLINS
State CO
Zip Code 80528-8941

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Taxonomy Information

Taxonomy Code 261QP3300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Pain

Taxonomy Definition

Definition to come...

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Competitor

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City FORT COLLINS
Zip Code 80528

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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