Provider Demographics
NPI:1780648741
Name:OB GYN ANESTHESIA PC
Entity Type:Organization
Organization Name:OB GYN ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-789-1940
Mailing Address - Street 1:300 E HAMPDEN AVE
Mailing Address - Street 2:202
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2654
Mailing Address - Country:US
Mailing Address - Phone:303-789-1940
Mailing Address - Fax:303-789-2132
Practice Address - Street 1:300 E HAMPDEN AVE
Practice Address - Street 2:202
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2654
Practice Address - Country:US
Practice Address - Phone:303-789-1940
Practice Address - Fax:303-789-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04001285Medicaid
C90604Medicare ID - Type Unspecified