Provider Demographics
NPI:1639255409
Name:ANESTHESIA & PAIN MANAGEMENT SERVICES OF PUEBLO
Entity Type:Organization
Organization Name:ANESTHESIA & PAIN MANAGEMENT SERVICES OF PUEBLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA-FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-543-7877
Mailing Address - Street 1:PO BOX 8971
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-8971
Mailing Address - Country:US
Mailing Address - Phone:719-543-7877
Mailing Address - Fax:719-543-7882
Practice Address - Street 1:400 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2745
Practice Address - Country:US
Practice Address - Phone:719-584-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2019-04-24
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
COC184608Medicare PIN