Basic Information
| Provider Information | |||||||||
| NPI: | 1851389613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN COLORADO ANESTHESIA PROFESSIONALS PLLC | ||||||||
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| OtherOrganizationName: | NCAP, PLLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 AUTOMATION WAY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805255738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702242985 | ||||||||
| FaxNumber: | 9702231118 | ||||||||
| Practice Location | |||||||||
| Address1: | 3702 AUTOMATION WAY STE 103 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805255738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702242985 | ||||||||
| FaxNumber: | 9702231118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | WOTOWEY | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9702242985 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 113844800 | 05 | WY | MEDICAID | 187269700 | 01 | CO | FEDERAL WORK COMP | OTHER | 04035054 | 05 | CO | MEDICAID | 0225723 | 01 | WA | WORK COMP | OTHER | XX-XXXXXXX15 | 05 | NE | MEDICAID |