Provider Demographics
NPI:1255666277
Name:SUMMIT ANESTHESIA
Entity Type:Organization
Organization Name:SUMMIT ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:303-917-4289
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0432
Mailing Address - Country:US
Mailing Address - Phone:303-445-4769
Mailing Address - Fax:303-445-1837
Practice Address - Street 1:761 SOUTHPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5644
Practice Address - Country:US
Practice Address - Phone:303-783-1003
Practice Address - Fax:303-445-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164334367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty