Organization
WIND RIVER PAIN MANAGEMENT, LLC
Active
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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