Healthcare Provider Details

I. General information

NPI: 1457998411
Provider Name (Legal Business Name): COMMUNITY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2596 F RD
GRAND JUNCTION CO
81505-1443
US

IV. Provider business mailing address

PO BOX 1727
GRAND JUNCTION CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-3180
  • Fax: 970-254-3198
Mailing address:
  • Phone: 970-254-3180
  • Fax: 970-254-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN THOMAS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 970-644-3011