Provider Demographics
NPI:1356835045
Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Entity Type:Organization
Organization Name:SCL HEALTH MEDICAL GROUP - GRAND JUNCTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE MGPS
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 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:627 25 1/2 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-6401
Practice Address - Country:US
Practice Address - Phone:970-242-3535
Practice Address - Fax:970-683-2745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF CHARITY LEAVENWORTH HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty