Healthcare Provider Details

I. General information

NPI: 1710196076
Provider Name (Legal Business Name): MESA COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29.5 ROAD
GRAND JUNCTION CO
81504
US

IV. Provider business mailing address

3097 A 1 2 ROAD
GRAND JUNCTION CO
81503
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-6919
  • Fax: 970-248-6913
Mailing address:
  • Phone: 970-434-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 74009
License Number StateCO

VIII. Authorized Official

Name: DR. MICHAEL ADUDDELL
Title or Position: DIRECTOR
Credential: DO
Phone: 970-248-6974