Basic Information
| Provider Information | |||||||||
| NPI: | 1457359820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO ANESTHESIA CONSULTANTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | STE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033776825 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SHERMAN STREET | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033776825 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 06/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOOS | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3033776825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP3000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 4044417 | 05 | TN | MEDICAID | 02179294 | 05 | MP | MEDICAID | 100214780A | 05 | KS | MEDICAID | 8648409 | 05 | NJ | MEDICAID | 3506685 | 05 | MT | MEDICAID | 04004388 | 05 | CO | MEDICAID | 074711501 | 05 | TX | MEDICAID | 107791100 | 05 | WY | MEDICAID | 003392900 | 05 | ID | MEDICAID | G2545 | 05 | NM | MEDICAID | 100756430A | 05 | OK | MEDICAID | 7105158 | 05 | WA | MEDICAID | 907490200 | 05 | FL | MEDICAID |