Provider Demographics
NPI:1376582767
Name:SOUTH DENVER ANESTHESIOLOGISTS PC
Entity Type:Organization
Organization Name:SOUTH DENVER ANESTHESIOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-783-4908
Mailing Address - Street 1:333 W. HAMPDEN AVE.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2336
Mailing Address - Country:US
Mailing Address - Phone:303-761-5646
Mailing Address - Fax:720-439-9500
Practice Address - Street 1:333 W. HAMPDEN AVE.
Practice Address - Street 2:SUITE 600
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2336
Practice Address - Country:US
Practice Address - Phone:303-761-5646
Practice Address - Fax:720-439-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04061081Medicaid
COCV1508Medicare PIN