Provider Demographics
NPI:1073757480
Name:ENDOSCOPY CENTER OF WESTERN COLORADO INC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF WESTERN COLORADO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-245-0990
Mailing Address - Street 1:2460 PATTERSON ROAD UNIT 4
Mailing Address - Street 2:PO BOX 1238
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1280
Mailing Address - Country:US
Mailing Address - Phone:970-245-0990
Mailing Address - Fax:970-245-2335
Practice Address - Street 1:2460 PATTERSON RD
Practice Address - Street 2:UNIT 4
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1280
Practice Address - Country:US
Practice Address - Phone:970-245-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical