Provider Demographics
NPI:1811042898
Name:ASPEN ANESTHESIA, INC
Entity Type:Organization
Organization Name:ASPEN ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-246-1591
Mailing Address - Street 1:PO BOX 3930
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3930
Mailing Address - Country:US
Mailing Address - Phone:800-880-3566
Mailing Address - Fax:800-880-3566
Practice Address - Street 1:401 CASTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1159
Practice Address - Country:US
Practice Address - Phone:844-246-1591
Practice Address - Fax:970-544-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29434C207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020079Medicaid
COCU7608Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER