Healthcare Provider Details

I. General information

NPI: 1265168504
Provider Name (Legal Business Name): CEDAR POINT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW 8TH AVE
CEDAREDGE CO
81413-3902
US

IV. Provider business mailing address

300 S NEVADA AVE
MONTROSE CO
81401-4273
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-7751
  • Fax: 970-541-9806
Mailing address:
  • Phone: 970-249-7751
  • Fax: 970-541-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CORY PHILLIPS
Title or Position: CEO
Credential:
Phone: 970-249-7751