Provider Demographics
NPI:1215049804
Name:ELITE ANESTHESIA CONCEPTS INC
Entity type:Organization
Organization Name:ELITE ANESTHESIA CONCEPTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERND
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-663-9118
Mailing Address - Street 1:PO BOX 974856
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-0001
Mailing Address - Country:US
Mailing Address - Phone:888-363-3318
Mailing Address - Fax:
Practice Address - Street 1:2909 CANON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5415
Practice Address - Country:US
Practice Address - Phone:303-663-9118
Practice Address - Fax:707-221-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28453207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37870734Medicaid
COC808338Medicare PIN