Healthcare Provider Details

I. General information

NPI: 1093620874
Provider Name (Legal Business Name): MONTROSE REGIONAL HEALTH PSO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S. FOURTH ST.
MONTROSE CO
81401
US

IV. Provider business mailing address

800 S 3RD ST
MONTROSE CO
81401-4212
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-6641
  • Fax: 970-249-5148
Mailing address:
  • Phone: 970-252-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA ANN SELF
Title or Position: CLAIMS ANALYST IV
Credential:
Phone: 970-252-2838