Healthcare Provider Details

I. General information

NPI: 1295073252
Provider Name (Legal Business Name): SUDERMAN ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2013
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 JERRY MURPHY RD
PUEBLO CO
81001-1045
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-3937
  • Fax: 719-635-3578
Mailing address:
  • Phone: 800-880-3566
  • Fax: 770-701-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG K SUDERMAN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 800-880-3566