Healthcare Provider Details

I. General information

NPI: 1134844558
Provider Name (Legal Business Name): COMMUNITY SPECIALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 PATTERSON RD STE 10
GRAND JUNCTION CO
81505-3607
US

IV. Provider business mailing address

PO BOX 1727
GRAND JCT CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-644-3190
  • Fax: 970-644-3965
Mailing address:
  • Phone: 970-644-3190
  • Fax: 970-644-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

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