Provider Demographics
NPI:1720111321
Name:COLORADO VALLEY ANESTHESIA, LLP
Entity Type:Organization
Organization Name:COLORADO VALLEY ANESTHESIA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-744-4835
Mailing Address - Street 1:519 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-2345
Mailing Address - Country:US
Mailing Address - Phone:979-732-9218
Mailing Address - Fax:
Practice Address - Street 1:519 SPRING ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2345
Practice Address - Country:US
Practice Address - Phone:979-732-9218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00913NMedicare ID - Type Unspecified