Provider Demographics
NPI:1407330046
Name:ALTITUDE ANESTHESIA GROUP
Entity Type:Organization
Organization Name:ALTITUDE ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-391-8331
Mailing Address - Street 1:5600 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7339
Mailing Address - Country:US
Mailing Address - Phone:720-907-1485
Mailing Address - Fax:
Practice Address - Street 1:5600 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7339
Practice Address - Country:US
Practice Address - Phone:720-907-1485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherIRS