Healthcare Provider Details

I. General information

NPI: 1427685247
Provider Name (Legal Business Name): PRIME ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S WILCOX ST # 56
CASTLE ROCK CO
80104-9997
US

IV. Provider business mailing address

PO BOX 56
CASTLE ROCK CO
80104-0056
US

V. Phone/Fax

Practice location:
  • Phone: 720-845-0007
  • Fax: 303-648-5800
Mailing address:
  • Phone: 720-845-0007
  • Fax: 303-648-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIA DALLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-845-0007