Healthcare Provider Details

I. General information

NPI: 1982914370
Provider Name (Legal Business Name): PARK MEADOWS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 PARK MEADOWS DRIVE SUITE 100
LONE TREE CO
80124
US

IV. Provider business mailing address

191 UNIVERSITY BLVD. #509
DENVER CO
80206
US

V. Phone/Fax

Practice location:
  • Phone: 303-367-2225
  • Fax: 303-343-8702
Mailing address:
  • Phone: 303-367-2225
  • Fax: 303-343-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11717821
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. PERRY L. HANEY
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 303-367-2225