MEDICARE: MESA COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	39245	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	P.O. BOX 20000
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81502-5033
Country	:	US
Telephone Number	:	970-248-6974
Fax Number	:	970-248-6974

Provider Business Practice Location Address
First Line	:	510 29 1/2 ROAD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504
Country	:	US
Telephone Number	:	970-248-6905
Fax Number	:	970-248-6977

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JEFFREY KUHR
Credential	:
Telephone Number	:	970-248-6974

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/14/2011

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Directions to “MESA COUNTY HEALTH DEPARTMENT ” Practice Location

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