1710266598 NPI number — COLORADO ANESTHESIA GROUP PLLC

Table of content: (NPI 1710266598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710266598 NPI number — COLORADO ANESTHESIA GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO ANESTHESIA GROUP PLLC
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:
1710266598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5665 NEW NORTHSIDE DR NW
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-874-5400
Provider Business Mailing Address Fax Number:
770-874-5483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAIL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81657-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-476-2451
Provider Business Practice Location Address Fax Number:
770-874-5483
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
PRESTON
Authorized Official Middle Name:
WILLIAMS
Authorized Official Title or Position:
CHIEF REVENUE OFFICER
Authorized Official Telephone Number:
770-874-5400

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)





Copyright © 2007-2025 www.npivalidator.com