Basic Information
| Provider Information | |||||||||
| NPI: | 1780911826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA ASSOCIATES OF THE FRONT RANGE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 S. WADSWORTH BLVD #100-D | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032051090 | ||||||||
| FaxNumber: | 3032055534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 SOUTHPARK DR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037228987 | ||||||||
| FaxNumber: | 3037222935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOUDZWAARD | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3032051090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 71671323 | 05 | CO | MEDICAID |