Provider Demographics
NPI:1770631202
Name:PHYSICIAN ANESTHESIA OF PUEBLO, PC
Entity Type:Organization
Organization Name:PHYSICIAN ANESTHESIA OF PUEBLO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-296-5840
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002-0570
Mailing Address - Country:US
Mailing Address - Phone:719-296-5840
Mailing Address - Fax:719-542-0746
Practice Address - Street 1:916 INDIANA AVE STE 120
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3572
Practice Address - Country:US
Practice Address - Phone:719-296-5840
Practice Address - Fax:719-542-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015962Medicaid
PH18408OtherBCBS
CH6461OtherRR MEDICARE
COC18408Medicare PIN