Provider Demographics
NPI:1700946506
Name:GITTELMAN ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:GITTELMAN ANESTHESIA SERVICES LLC
Other - Org Name:ROCKY MOUNTAIN MIND AND BODY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GITTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:303-204-5129
Mailing Address - Street 1:25587 CONIFER RD
Mailing Address - Street 2:SUITE105-603
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9067
Mailing Address - Country:US
Mailing Address - Phone:303-204-5129
Mailing Address - Fax:
Practice Address - Street 1:25587 CONIFER RD STE 105-603
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9067
Practice Address - Country:US
Practice Address - Phone:303-204-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCRA-3520367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80177069Medicaid
NM300521148Medicare PIN