Provider Demographics
NPI:1982914370
Name:PARK MEADOWS ANESTHESIA, LLC
Entity Type:Organization
Organization Name:PARK MEADOWS ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-367-2225
Mailing Address - Street 1:191 UNIVERSITY BLVD.
Mailing Address - Street 2:#509
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-367-2225
Mailing Address - Fax:303-343-8702
Practice Address - Street 1:8500 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-367-2225
Practice Address - Fax:303-343-8702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE ONE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11717821367500000X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA107099Medicare UPIN