Basic Information
| Provider Information | |||||||||
| NPI: | 1194792036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S ANESTHESIA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033368304 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033368304 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MERRITT | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3038616224 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 04020566 | 05 | CO | MEDICAID | 14730 | 05 | ND | MEDICAID | 7781590 | 05 | SD | MEDICAID | 3500334 | 05 | MT | MEDICAID | Q6547 | 05 | NM | MEDICAID |