Healthcare Provider Details

I. General information

NPI: 1407330046
Provider Name (Legal Business Name): ALTITUDE ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W 44TH AVE
DENVER CO
80212-7339
US

IV. Provider business mailing address

5600 W 44TH AVE
DENVER CO
80212-7339
US

V. Phone/Fax

Practice location:
  • Phone: 720-907-1485
  • Fax:
Mailing address:
  • Phone: 720-907-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY VAN HILSEN
Title or Position: ADMINISTRATOR
Credential: DDS
Phone: 602-391-8331