Provider Demographics
NPI:1578583316
Name:GRAND VALLEY INTERNAL MEDICINE, ASSOCIATES
Entity Type:Organization
Organization Name:GRAND VALLEY INTERNAL MEDICINE, ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-244-7460
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1953
Mailing Address - Country:US
Mailing Address - Phone:970-244-7460
Mailing Address - Fax:
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:SUITE 403
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1953
Practice Address - Country:US
Practice Address - Phone:970-244-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COL2808Medicare PIN