Basic Information
| Provider Information | |||||||||
| NPI: | 1144487687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CELECHOVSKY | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 150 | ||||||||
| Address2: | |||||||||
| City: | HOLLY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810470150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195370712 | ||||||||
| FaxNumber: | 7195376284 | ||||||||
| Practice Location | |||||||||
| Address1: | 4231 W 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802041335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195370712 | ||||||||
| FaxNumber: | 7195376284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MT184032 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MT184032 | 01 | PA | LICENSE | OTHER |