Healthcare Provider Details

I. General information

NPI: 1093970196
Provider Name (Legal Business Name): MARK S THOMAS RRT, UXO 1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 MEADOWOOD ST
GRAND JUNCTION CO
81504-6977
US

IV. Provider business mailing address

649 MEADOWOOD ST
GRAND JUNCTION CO
81504-6977
US

V. Phone/Fax

Practice location:
  • Phone: 970-434-9971
  • Fax:
Mailing address:
  • Phone: 970-434-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: