Provider Demographics
NPI:1942734272
Name:EASTERN PLAINS ANESTHESIA & PAIN SERVICES, LLC IN RECEIVERSHIP
Entity Type:Organization
Organization Name:EASTERN PLAINS ANESTHESIA & PAIN SERVICES, LLC IN RECEIVERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-796-1104
Mailing Address - Street 1:5299 DTC BLVD., SUITE 815
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-796-1104
Mailing Address - Fax:303-721-7769
Practice Address - Street 1:12769 COUNTY ROAD W.5
Practice Address - Street 2:
Practice Address - City:WELDONA
Practice Address - State:CO
Practice Address - Zip Code:80653-8304
Practice Address - Country:US
Practice Address - Phone:303-796-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty