MEDICARE: GASTROENTEROLOGY ASSOCIATES OF WESTERN COLORADO,P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	DR44639	CO

General Provider Information

NPI Number	:	1730386939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES OF WESTERN COLORADO,P C

Provider Business Mailing Address
First Line	:	744 HORIZON CT
Second Line	:	SUITE 350 GI
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-3921
Country	:	US
Telephone Number	:	970-245-0990
Fax Number	:	970-245-2335

Provider Business Practice Location Address
First Line	:	744 HORIZON CT
Second Line	:	SUITE 350GI
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-3921
Country	:	US
Telephone Number	:	970-245-0990
Fax Number	:	970-245-2335

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MASI KHAJA
Credential	:	M.D.
Telephone Number	:	970-245-0990

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	11/30/2007

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