Healthcare Provider Details

I. General information

NPI: 1295697548
Provider Name (Legal Business Name): MONTROSE REGIONAL HEALTH PSO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PACIFIC AVE
TELLURIDE CO
81435
US

IV. Provider business mailing address

800 S 3RD ST
MONTROSE CO
81401-4212
US

V. Phone/Fax

Practice location:
  • Phone: 970-497-2584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGAN BEAVER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 970-252-2691