Basic Information
| Provider Information | |||||||||
| NPI: | 1902853765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO AMBULATORY ANESTHESIA SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 DENVER WEST DR | ||||||||
| Address2: | BLDG 26 STE 200 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | 3034229474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1819 DENVER WEST DR | ||||||||
| Address2: | BLDG 26 STE 200 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | 3034229474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 09/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | DOUGALL | ||||||||
| AuthorizedOfficialFirstName: | DORIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MAMAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3034229438 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 08305587 | 05 | CO | MEDICAID |