Provider Demographics
NPI:1346854130
Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Entity Type:Organization
Organization Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Other - Org Name:MOAB NEUROLOGY SATELLITE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE MEDICAL GROUP
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 1:476 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2186
Mailing Address - Country:US
Mailing Address - Phone:435-719-5550
Mailing Address - Fax:435-719-5501
Practice Address - Street 1:476 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2186
Practice Address - Country:US
Practice Address - Phone:435-719-5550
Practice Address - Fax:435-719-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH FRONT RANGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension SpecialistGroup - Multi-Specialty