Healthcare Provider Details

I. General information

NPI: 1760477699
Provider Name (Legal Business Name): CHILDREN'S ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 E 19TH AVE
DENVER CO
80218-1007
US

IV. Provider business mailing address

455 SHERMAN ST SUITE 510
DENVER CO
80203-4400
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-6226
  • Fax:
Mailing address:
  • Phone: 303-377-7638
  • Fax: 303-780-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GLENN MERRITT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-861-6226