Healthcare Provider Details
I. General information
NPI: 1083768394
Provider Name (Legal Business Name): SPRINGS ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/23/2007
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1615 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-5788
US
IV. Provider business mailing address
PO BOX 76510
COLORADO SPRINGS CO
80970-6510
US
V. Phone/Fax
- Phone: 719-636-3555
- Fax: 719-635-7750
- Phone: 719-638-8844
- Fax: 719-638-8115
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JAMES
EDWARD
ROLLMAN
Title or Position: OWNER
Credential: M.D.
Phone: 719-636-3555