=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992734651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAIL VALLEY ANESTHESIA, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 04/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 W MEADOW DR
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81657-5242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-422-9438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5525
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80217-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-422-9438
-----------------------------------------------------
Fax | 303-422-9474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMY MILLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-422-9438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 36117
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------