Provider Demographics
NPI:1689098295
Name:COMMUNITY MEDICAL GROUP
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL GROUP
Other - Org Name:COLORADO WEST WOMANCARE OF THE GRAND VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-644-3011
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-243-7908
Mailing Address - Fax:970-245-0656
Practice Address - Street 1:2373 G RD STE 240
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-7908
Practice Address - Fax:970-245-0656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000151935Medicaid