Basic Information
| Provider Information | |||||||||
| NPI: | 1376582767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH DENVER ANESTHESIOLOGISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W. HAMPDEN AVE. | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W. HAMPDEN AVE. | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 7204399500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | LEORA | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3037834908 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 04061081 | 05 | CO | MEDICAID |