Provider Demographics
NPI:1780911826
Name:ANESTHESIA ASSOCIATES OF THE FRONT RANGE LLC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF THE FRONT RANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDZWAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-205-1090
Mailing Address - Street 1:3333 S. WADSWORTH BLVD #100-D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-5534
Practice Address - Street 1:1001 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:303-722-8987
Practice Address - Fax:303-722-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71671323Medicaid
CO71671323Medicaid