Organization
ESTES VALLEY ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON GOODWIN CRNA (OWNER)
(970) 443-8855
Entity
Organization
Contact information
Practice address
850 NORTH LN, ESTES PARK, CO 80517-9629
(970) 443-8855
Mailing address
850 NORTH LN, ESTES PARK, CO 80517-9629
(970) 443-8855
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRA-2933
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17228042
—
CO
05
—
52909361
—
CO
01
—
C188438
MEDICARE ID FOR JASON GOODWIN
CO
01
—
C802029
MEDICARE ID FOR MARY BOLGEO
CO
Enumeration date
05/12/2011
Last updated
05/12/2011
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