Provider Demographics
NPI:1477660850
Name:ANNEST SYNN NOWAK & MUBARAK PROFESSIONAL LLC
Entity Type:Organization
Organization Name:ANNEST SYNN NOWAK & MUBARAK PROFESSIONAL LLC
Other - Org Name:VASCULAR INSTITUTE OF THE ROCKIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-880-7839
Mailing Address - Street 1:4105 E FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3641
Mailing Address - Country:US
Mailing Address - Phone:303-539-0736
Mailing Address - Fax:303-539-0737
Practice Address - Street 1:4105 E FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3641
Practice Address - Country:US
Practice Address - Phone:303-539-0736
Practice Address - Fax:303-539-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016515Medicaid
COCR1090OtherRAILROAD MEDICARE
KS110243Medicare PIN
CO04016515Medicaid