Basic Information
| Provider Information | |||||||||
| NPI: | 1437112273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA CONSULTANTS OF WESTERN COLORADO, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 WELLINGTON AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815016129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702437245 | ||||||||
| FaxNumber: | 9702411308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 WELLINGTON AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815016129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702437245 | ||||||||
| FaxNumber: | 9702411308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOECKEL | ||||||||
| AuthorizedOfficialFirstName: | ERNEST | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9702437245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| 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 | 04020368 | 05 | CO | MEDICAID | CI2171 | 01 | RAILROAD MEDICARE | OTHER |