| Boulder Headache And Pain Pllc | |
|
5377 Manhattan Cir Ste 200 Boulder CO 80303-4345 | |
| (303) 225-6625 | |
| (303) 225-6626 |
| Full Name | Boulder Headache And Pain Pllc |
|---|---|
| Speciality | Neuromusculoskeletal Medicine & OMM |
| Location | 5377 Manhattan Cir Ste 200, Boulder, Colorado |
| Authorized Official Name and Position | Alex G Reish (OWNER) |
| Authorized Official Contact | 3032256625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulder Headache And Pain Pllc 5377 Manhattan Cir Ste 200 Boulder CO 80303-4345 Ph: (303) 225-6625 | Boulder Headache And Pain Pllc 5377 Manhattan Cir Ste 200 Boulder CO 80303-4345 Ph: (303) 225-6625 |
| NPI Number | 1114432903 |
|---|---|
| Provider Enumeration Date | 12/04/2017 |
| Last Update Date | 09/19/2019 |
| Medicare PECOS PAC ID | 1557620721 |
|---|---|
| Medicare Enrollment ID | O20180116000046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114432903 | NPI | - | NPPES |
| 62451383 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 46517 (Colorado) | Secondary |
| 204D00000X | Neuromusculoskeletal Medicine & Omm | 46517 (Colorado) | Primary |
| Provider Name | Alex G P Reish |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1760694525 PECOS PAC ID: 0749362440 Enrollment ID: I20081120000385 |
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