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General NPI Number Information
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NPI Number | 1891622650
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Entity Type | Organization
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Legal Business Name | COMMUNITY SPECIALTY GROUP LLC
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 2351 G RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-9641
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Country | US
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Telephone | 970-242-0920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1727
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-1727
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Country | US
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Telephone | 970-242-0920
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING OFFICER
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Name | DESIRAE DEGEUS
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Credential |
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Telephone | 970-263-2619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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