Provider Demographics
NPI:1518042712
Name:ALLEGRO ANESTHESIA, PC
Entity type:Organization
Organization Name:ALLEGRO ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-778-0885
Mailing Address - Street 1:411 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERY
Mailing Address - State:SD
Mailing Address - Zip Code:57332-2124
Mailing Address - Country:US
Mailing Address - Phone:970-778-0885
Mailing Address - Fax:
Practice Address - Street 1:411 N 6TH ST
Practice Address - Street 2:
Practice Address - City:EMERY
Practice Address - State:SD
Practice Address - Zip Code:57332-2124
Practice Address - Country:US
Practice Address - Phone:970-778-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43593207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90808347Medicaid
CO80224Medicare ID - Type Unspecified