Provider Demographics
NPI: | 1013360775 |
---|---|
Name: | MORPHEUS ANESTHESIA, LLC |
Entity Type: | Organization |
Organization Name: | MORPHEUS ANESTHESIA, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CRAIG |
Authorized Official - Middle Name: | WILLIAM |
Authorized Official - Last Name: | GOODSELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 719-648-5678 |
Mailing Address - Street 1: | 7757 CRESTONE PEAK TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | COLORADO SPRINGS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80924-6029 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-648-5678 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 575 RIVERGATE |
Practice Address - Street 2: | |
Practice Address - City: | DURANGO |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81301-7487 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-648-5678 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-07-18 |
Last Update Date: | 2016-07-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | DR-45552 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Single Specialty |