Healthcare Provider Details

I. General information

NPI: 1053438663
Provider Name (Legal Business Name): PREMIER ANESTHESIA OF COLORADO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E HARVARD AVE STE 200
DENVER CO
80210-5824
US

IV. Provider business mailing address

1819 DENVER WEST DR SUITE 200
LAKEWOOD CO
80401-3118
US

V. Phone/Fax

Practice location:
  • Phone: 303-468-8844
  • Fax:
Mailing address:
  • Phone: 303-422-9438
  • Fax: 303-422-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY M WHITE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 303-422-9438