Provider Demographics
NPI:1831487289
Name:CCC OF NORTHERN COLORADO PLLC
Entity type:Organization
Organization Name:CCC OF NORTHERN COLORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-420-1906
Mailing Address - Street 1:1124 W DILLON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1290
Mailing Address - Country:US
Mailing Address - Phone:303-926-6865
Mailing Address - Fax:303-604-6044
Practice Address - Street 1:1124 W DILLON RD STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1290
Practice Address - Country:US
Practice Address - Phone:303-926-6865
Practice Address - Fax:303-604-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty