Provider Demographics
NPI:1730692054
Name:ROCKY MOUNTAIN STATE ANESTHESIA PROVIDERS
Entity type:Organization
Organization Name:ROCKY MOUNTAIN STATE ANESTHESIA PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARMOSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-654-5262
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1786
Mailing Address - Country:US
Mailing Address - Phone:855-654-5262
Mailing Address - Fax:
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-810-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty