Provider Demographics
NPI:1295073252
Name:SUDERMAN ANESTHESIA INC
Entity type:Organization
Organization Name:SUDERMAN ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:800-880-3566
Mailing Address - Street 1:PO BOX 3750
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3750
Mailing Address - Country:US
Mailing Address - Phone:800-880-3566
Mailing Address - Fax:770-701-6676
Practice Address - Street 1:4026 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1045
Practice Address - Country:US
Practice Address - Phone:719-630-3937
Practice Address - Fax:719-635-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty