1457359820 NPI number — COLORADO ANESTHESIA CONSULTANTS, P.C.

Table of content: (NPI 1457359820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457359820 NPI number — COLORADO ANESTHESIA CONSULTANTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO ANESTHESIA CONSULTANTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457359820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SHERMAN ST
Provider Second Line Business Mailing Address:
STE 510
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80203-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-6825
Provider Business Mailing Address Fax Number:
303-780-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SHERMAN STREET
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80203-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-377-6825
Provider Business Practice Location Address Fax Number:
303-780-0787
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOOS
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
303-377-6825

Provider Taxonomy Codes

  • Taxonomy code: 207LC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4044417 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02179294 , issued by the state of ( MP ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100214780A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8648409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3506685 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04004388 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 074711501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107791100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003392900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: G2545 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100756430A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7105158 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 907490200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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