Provider Demographics
NPI:1083335079
Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Entity Type:Organization
Organization Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Other - Org Name:WELLINGTON OB-GYN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-272-0231
Mailing Address - Street 1:500 ELDORADO BLVD STE 4300
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3564
Mailing Address - Country:US
Mailing Address - Phone:303-272-0566
Mailing Address - Fax:303-272-0390
Practice Address - Street 1:2525 N 8TH ST STE 202
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8847
Practice Address - Country:US
Practice Address - Phone:970-245-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH FRONT RANGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty