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NPI Code Detail

MEDICARE: MID WEST ANESTHESIA CONSULTANTS LLC

MEDICARE: MID WEST ANESTHESIA CONSULTANTS LLC
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
1367500000XCertified Registered Nurse Anesthetist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1670461OTHERCOBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4180052OTHERKSBCBS
5610158300OTHERUS DEPT OF LABOR

General Provider Information

NPI Number : 1558327056
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID WEST ANESTHESIA CONSULTANTS LLC
Provider Business Mailing Address
First Line : DEPT 6055
Second Line :
City : LOS ANGELES
State : CA
Zip : 90084-0001
Country : US
Telephone Number : 800-204-0099
Fax Number :
Provider Business Practice Location Address
First Line : 615 FAIRHURST ST
Second Line :
City : STERLING
State : CO
Zip : 80751-4564
Country : US
Telephone Number : 970-521-3132
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DARYL HARRIMAN
Credential : CRNA
Telephone Number : 970-521-3132
Provider Enumeration Date : 04/24/2006
Last Update Date : 03/10/2008

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Directions to “MID WEST ANESTHESIA CONSULTANTS LLC ” Practice Location

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