Provider Demographics
NPI:1295166072
Name:JENNIFER STROH DO FAMILY MEDICINE
Entity type:Organization
Organization Name:JENNIFER STROH DO FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STROH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-256-1664
Mailing Address - Street 1:2139 N 12TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2901
Mailing Address - Country:US
Mailing Address - Phone:970-256-1664
Mailing Address - Fax:970-256-1707
Practice Address - Street 1:2139 N 12TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2901
Practice Address - Country:US
Practice Address - Phone:970-256-1664
Practice Address - Fax:970-256-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41942261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53307577Medicaid
CO53307577Medicaid
H36631Medicare UPIN