Provider Demographics
NPI:1750769295
Name:ADVANCED SPECIALTY ANESTHESIA COLORADO, LLC
Entity type:Organization
Organization Name:ADVANCED SPECIALTY ANESTHESIA COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SHAREHOLDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:785-856-6170
Mailing Address - Street 1:13918 EAST MISSISSIPPI AVENUE
Mailing Address - Street 2:BOX 339
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012
Mailing Address - Country:US
Mailing Address - Phone:785-856-6170
Mailing Address - Fax:785-856-6171
Practice Address - Street 1:15121 EAST MISSISSIPPI
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-802-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty