Organization
WIND RIVER PAIN MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES ALAN DERRISAW M.D. (CEO)
(970) 420-9904
Entity
Organization
Contact information
Practice address
5873 HIGHLAND HILLS CIR, FORT COLLINS, CO 80528-8941
(970) 420-9904
Mailing address
5873 HIGHLAND HILLS CIR, FORT COLLINS, CO 80528-8941
(970) 420-9904
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
39525
CO
Other
Enumeration date
11/28/2006
Last updated
08/22/2020
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