Healthcare Provider Details

I. General information

NPI: 1821170192
Provider Name (Legal Business Name): EDWARD A SNIDER JR. R.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JUNCTION CO
81501-6428
US

IV. Provider business mailing address

481 E CHUKAR WAY
CLIFTON CO
81520-8876
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-2800
  • Fax: 970-244-7735
Mailing address:
  • Phone: 970-434-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number1385
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: