Provider Demographics
NPI:1982799680
Name:COLORADO WEST HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:COLORADO WEST HEALTHCARE SYSTEM
Other - Org Name:ORCHARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-256-6200
Mailing Address - Street 1:1060 ORCHARD AVE.
Mailing Address - Street 2:UNIT A
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2997
Mailing Address - Country:US
Mailing Address - Phone:970-243-3400
Mailing Address - Fax:970-243-6012
Practice Address - Street 1:1060 ORCHARD AVE.
Practice Address - Street 2:UNIT A
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2997
Practice Address - Country:US
Practice Address - Phone:970-243-3400
Practice Address - Fax:970-243-6012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO WEST HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO530000008183500000X
CO05300000083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03000643Medicaid