Provider Demographics
NPI:1770214512
Name:ALLERGY & ASTHMA CENTER OF WESTERN COLORADO P C
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF WESTERN COLORADO P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-241-0170
Mailing Address - Street 1:1120 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6129
Mailing Address - Country:US
Mailing Address - Phone:970-241-0170
Mailing Address - Fax:970-241-2035
Practice Address - Street 1:100 TESSITORE CT UNIT B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5689
Practice Address - Country:US
Practice Address - Phone:970-241-0170
Practice Address - Fax:970-241-2035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLERGY & ASTHMA CENTER OF WESTERN COLORADO P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty