Lifelinc Anesthesia Colorado LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

LIFELINC ANESTHESIA COLORADO LLC

Practice address

615 Fairhurst St
Sterling, CO 80751-4523

Phone

(970) 522-0122

NPI assigned

Mar 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Erica Warren, COO

Title

Coo

Phone

(901) 207-2017

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1558863415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 PLAYERS CLUB PKWY STE 350",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381258949",
            "telephone_number": "901-844-1590",
            "fax_number": "844-752-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 FAIRHURST ST",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514523",
            "telephone_number": "970-522-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINC ANESTHESIA COLORADO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-06",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "901-207-2017",
        "authorized_official_credential": "COO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000161951",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.