Provider Demographics
NPI:1568695302
Name:WESTERN SLOPE ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:WESTERN SLOPE ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-263-2650
Mailing Address - Street 1:1212 BOOKCLIFF AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8161
Mailing Address - Country:US
Mailing Address - Phone:970-263-2650
Mailing Address - Fax:970-263-2695
Practice Address - Street 1:1212 BOOKCLIFF AVE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8161
Practice Address - Country:US
Practice Address - Phone:970-263-2650
Practice Address - Fax:970-263-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46947207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08109346Medicaid