Basic Information
| Provider Information | |||||||||
| NPI: | 1619016938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN ANESTHESIA CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 467 | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800010467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034227991 | ||||||||
| FaxNumber: | 3034227994 | ||||||||
| Practice Location | |||||||||
| Address1: | 2551 W 84TH AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800313807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034262500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | ESCAJEDA | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034227991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 04011789 | 05 | CO | MEDICAID |