Healthcare Provider Details

I. General information

NPI: 1750554176
Provider Name (Legal Business Name): BENCHMARK ANESTHESIA CONSULTANTS PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ALPINE AVE
BOULDER CO
80304-3504
US

IV. Provider business mailing address

1320 ALPINE AVE
BOULDER CO
80304-3504
US

V. Phone/Fax

Practice location:
  • Phone: 303-817-2840
  • Fax: 303-544-9101
Mailing address:
  • Phone: 303-817-2840
  • Fax: 303-544-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MALCOLM J MONLEZUN
Title or Position: PARTNER
Credential:
Phone: 303-817-2840