Organization
EDMISTON ANESTHESIA SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S EDMISTON (PRESIDENT)
(970) 259-2525
Entity
Organization
Contact information
Practice address
575 RIVERGATE, DURANGO, CO 81301-7487
(970) 247-3537
Mailing address
PO BOX 15000, DURANGO, CO 81302-8901
(970) 259-2525
(970) 247-0421
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37536079
—
CO
05
—
790403
—
AZ
05
—
X9058
—
NM
Enumeration date
01/10/2007
Last updated
05/01/2008
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