Healthcare Provider Details

I. General information

NPI: 1942138979
Provider Name (Legal Business Name): COLORADO SURGICAL AFFILIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 CROSSROADS BLVD
GRAND JUNCTION CO
81506-3954
US

IV. Provider business mailing address

2440 N 11TH ST
GRAND JUNCTION CO
81501-8102
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-3061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE S NESTLE
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 970-244-5945