Healthcare Provider Details

I. General information

NPI: 1295639870
Provider Name (Legal Business Name): INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N
BILLINGS MT
59101-7506
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 4300
BROOMFIELD CO
80021-3564
US

V. Phone/Fax

Practice location:
  • Phone: 303-403-3309
  • Fax: 406-545-6191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AWTREY CHRISTOPHER
Title or Position: ASSOCIATE CHIEF MEDICAL OFFICER
Credential: MD
Phone: 303-272-0756