Basic Information
| Provider Information | |||||||||
| NPI: | 1184924946 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON STREET ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 MADISON ST | ||||||||
| Address2: | 355 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802065419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033772020 | ||||||||
| FaxNumber: | 3033772022 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 MADISON ST | ||||||||
| Address2: | 355 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802065419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033772020 | ||||||||
| FaxNumber: | 3033772022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZEBARTH | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT - FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3034680432 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MADISON STREET PROVIDER NETWORK | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.