Healthcare Provider Details

I. General information

NPI: 1811279870
Provider Name (Legal Business Name): COLORADO ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 E 9TH AVE
DENVER CO
80220-3908
US

IV. Provider business mailing address

PO BOX 6277
AURORA CO
80045-0277
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-2394
  • Fax: 303-320-2200
Mailing address:
  • Phone: 303-250-4008
  • Fax: 303-422-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42125
License Number StateCO

VIII. Authorized Official

Name: DR. FADI NASRALLAH
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 303-250-4008