Provider Demographics
NPI:1124687926
Name:COMPLETE CARE OFFICE ANESTHESIA LLC
Entity type:Organization
Organization Name:COMPLETE CARE OFFICE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-763-0499
Mailing Address - Street 1:4970 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-8976
Mailing Address - Country:US
Mailing Address - Phone:720-763-0499
Mailing Address - Fax:
Practice Address - Street 1:9320 GRAND CORDERA PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7003
Practice Address - Country:US
Practice Address - Phone:719-258-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty