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General NPI Number Information
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NPI Number | 1235003351
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Entity Type | Organization
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Legal Business Name | BESPOKE ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 3151 PRECISION DR
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City | FORT COLLINS
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State | CO
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Zip | 80528-4601
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Country | US
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Telephone | 970-221-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 5538 GOLDEN WILLOW DR
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City | FORT COLLINS
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State | CO
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Zip | 80528-6395
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Country | US
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Telephone | 404-825-3073
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MYA MONTOYA
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Credential |
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Telephone | 404-825-3073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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