Healthcare Provider Details

I. General information

NPI: 1063463248
Provider Name (Legal Business Name): ROCKY MOUNTAIN PEDIATRIC ANESTHESIOLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WILD PLUM LN
LITTLETON CO
80123-6617
US

IV. Provider business mailing address

57 WILD PLUM LN
LITTLETON CO
80123-6617
US

V. Phone/Fax

Practice location:
  • Phone: 303-921-4370
  • Fax:
Mailing address:
  • Phone: 970-664-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35876
License Number StateCO

VIII. Authorized Official

Name: BETH KATUBIG
Title or Position: PROVIDER
Credential:
Phone: 303-921-4370