Healthcare Provider Details

I. General information

NPI: 1205208360
Provider Name (Legal Business Name): MONUMENT ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 308
GRAND JUNCTION CO
81502-0308
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-1686
  • Fax:
Mailing address:
  • Phone: 970-254-1686
  • Fax: 970-254-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0109969
License Number StateCO

VIII. Authorized Official

Name: CHRISTINE A HAMILTON
Title or Position: OWNER
Credential: CRNA
Phone: 970-260-6556