Provider Demographics
NPI:1194792036
Name:CHILDREN'S ANESTHESIA, P.C.
Entity type:Organization
Organization Name:CHILDREN'S ANESTHESIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-861-6224
Mailing Address - Street 1:455 SHERMAN ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4400
Mailing Address - Country:US
Mailing Address - Phone:303-336-8304
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:455 SHERMAN ST
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4400
Practice Address - Country:US
Practice Address - Phone:303-336-8304
Practice Address - Fax:303-780-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020566Medicaid
ND14730Medicaid
SD7781590Medicaid
MT3500334Medicaid
NMQ6547Medicaid
MT3500334Medicaid
NMQ6547Medicaid