Provider Demographics
NPI:1063463248
Name:ROCKY MOUNTAIN PEDIATRIC ANESTHESIOLOGY,PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PEDIATRIC ANESTHESIOLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATUBIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-891-4029
Mailing Address - Street 1:4875 WARD ROAD
Mailing Address - Street 2:STE 600
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-463-5790
Mailing Address - Fax:303-463-7560
Practice Address - Street 1:7880 GALILEO WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125
Practice Address - Country:US
Practice Address - Phone:303-921-4370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
CO35876207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01358761Medicaid
CO12538515Medicaid
COF69777Medicare UPIN
CO12538515Medicaid