Healthcare Provider Details

I. General information

NPI: 1366765646
Provider Name (Legal Business Name): CHAYJAY LLC DBA MOUNTAIN PEAKS URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 S TOWNSEND AVE STE C
MONTROSE CO
81401-4360
US

IV. Provider business mailing address

836 S TOWNSEND AVE STE C
MONTROSE CO
81401-4360
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-2118
  • Fax: 970-249-2187
Mailing address:
  • Phone: 970-249-2118
  • Fax: 970-249-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRY S WADE
Title or Position: OWNER
Credential: D.O.
Phone: 970-249-2118