Healthcare Provider Details

I. General information

NPI: 1013335389
Provider Name (Legal Business Name): GLENWOOD ANESTHESIA PROFESSIONALS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4227
US

IV. Provider business mailing address

PO BOX 475
GRETNA NE
68028-0475
US

V. Phone/Fax

Practice location:
  • Phone: 800-903-2088
  • Fax:
Mailing address:
  • Phone: 800-914-4115
  • Fax:

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. ALLLSON LONG
Title or Position: OWNER MANAGER
Credential: MD
Phone: 720-987-4298