1053438663 NPI number — PREMIER ANESTHESIA OF COLORADO, INC

Table of content: (NPI 1053438663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053438663 NPI number — PREMIER ANESTHESIA OF COLORADO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ANESTHESIA OF COLORADO, INC
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:
1053438663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1819 DENVER WEST DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-422-9438
Provider Business Mailing Address Fax Number:
303-422-9474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E HARVARD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-468-8844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
303-422-9438

Provider Taxonomy Codes

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

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

  • Identifier: 1730126061 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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