Look up the most recent NPI and PECOS records

Ian H Black

Anesthesiology

Allopathic & Osteopathic Physicians

111 Colchester Ave, Fletcher Allen Health Care Department Of Anesthesiology, Burlington, VT 05401

PECOS Enrollment

This provider is enrolled in PECOS as IAN BLACK.

Based on the most recent information from CMS, provider Ian H Black is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1134110109
Provider Type
Individual
Full Name
Black, Ian H
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
10/31/2005
Last Updated
7/2/2021

Contact Information

Practice Location

111 Colchester Ave, Fletcher Allen Health Care Department Of Anesthesiology, Burlington, VT 05401

(802) 847-2415

(802) 847-5324

Mailing Location

1801 16th St, Greeley, CO 80631-5154

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License DR.0065589 Colorado
Code 207L00000X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 01053867A Indiana
Code 207LC0200X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 042-0011556 Vermont
Code 207LP2900X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 042-0011556 Vermont
Code 207L00000X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 042-0011556 Vermont

Ian H Black

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Davidson, Melissa L.

Elliott, Riley A

Mathews, Donald

Mason, Stephen B

Oberding, Michael John

Danles, Jennifer

Kreutz, Joseph M

Tharp, William Gabriel

Fletcher Allen Health Care Specialty Services, Llc

Gage, Jennifer Cerny