Healthcare Provider Details

I. General information

NPI: 1508473513
Provider Name (Legal Business Name): MOBILE ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S YORK ST
DENVER CO
80210-1913
US

IV. Provider business mailing address

1260 S YORK ST
DENVER CO
80210-1913
US

V. Phone/Fax

Practice location:
  • Phone: 303-704-1801
  • Fax: 303-777-5619
Mailing address:
  • Phone: 303-704-1801
  • Fax: 303-777-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA ANDERSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 720-810-8384