Provider Demographics
NPI:1952476392
Name:GRAND JUNCTION EMERGENCY MEDICAL GROUP
Entity Type:Organization
Organization Name:GRAND JUNCTION EMERGENCY MEDICAL GROUP
Other - Org Name:COMMUNITY HOSPITAL ER PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-256-6395
Mailing Address - Street 1:2021 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2980
Mailing Address - Country:US
Mailing Address - Phone:970-256-6395
Mailing Address - Fax:970-253-6520
Practice Address - Street 1:2021 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2980
Practice Address - Country:US
Practice Address - Phone:970-256-6395
Practice Address - Fax:970-253-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty