=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649218991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAND RIVER HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 AIRPORT RD
-----------------------------------------------------
City | RIFLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81650-8510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-625-1510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 AIRPORT RD
-----------------------------------------------------
City | RIFLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81650-8510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-625-1510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JAMES CURTIS COOMBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-625-6405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 010830
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------