MEDICARE: PREMIER ANESTHESIA OF COLORADO, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730126061	OTHER		NPI

General Provider Information

NPI Number	:	1053438663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ANESTHESIA OF COLORADO, INC

Provider Business Mailing Address
First Line	:	1819 DENVER WEST DR
Second Line	:	SUITE 200
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3118
Country	:	US
Telephone Number	:	303-422-9438
Fax Number	:	303-422-9474

Provider Business Practice Location Address
First Line	:	1000 E HARVARD AVE STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5824
Country	:	US
Telephone Number	:	303-468-8844
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GREGORY M WHITE
Credential	:	MD
Telephone Number	:	303-422-9438

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	04/26/2021

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