Healthcare Provider Details

I. General information

NPI: 1447920228
Provider Name (Legal Business Name): ST MARY'S HOSPITAL AND MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 29 RD
GRAND JUNCTION CO
81504-8901
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 6300
BROOMFIELD CO
80021-3422
US

V. Phone/Fax

Practice location:
  • Phone: 970-985-7467
  • Fax: 970-666-5125
Mailing address:
  • Phone: 303-272-0566
  • Fax: 303-272-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRI L CHINN
Title or Position: VP FINANCE
Credential:
Phone: 970-298-2020