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
StateLicense IDTaxonomies
CODR-45552207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty