Healthcare Provider Details

I. General information

NPI: 1164997524
Provider Name (Legal Business Name): COMMUNITY MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 G RD STE 280
GRAND JUNCTION CO
81505-1006
US

IV. Provider business mailing address

PO BOX 1727
GRAND JUNCTION CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-9340
  • Fax: 970-241-6894
Mailing address:
  • Phone: 970-263-2619
  • Fax: 970-263-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN THOMAS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 970-242-0920