=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346100427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTROSE REGIONAL HEALTH PSO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 PALMER ST
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-1735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-252-1020
-----------------------------------------------------
Fax | 970-252-1041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 S 3RD ST
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81401-4212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | MEGAN BEAVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-252-2691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------