Healthcare Provider Details

I. General information

NPI: 1043663594
Provider Name (Legal Business Name): COLORADO SURGICAL AFFILIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 970-243-0900
  • Fax: 970-245-4235
Mailing address:
  • Phone: 970-243-0900
  • Fax: 970-245-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
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