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NPI Code Detail

MEDICARE: COLORADO MESA UNIVERSITY

MEDICARE: COLORADO MESA UNIVERSITY
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician
2207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1629452255
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORADO MESA UNIVERSITY
Provider Business Mailing Address
First Line : PO BOX 650850
Second Line : DEPT 1011
City : DALLAS
State : TX
Zip : 75265-0850
Country : US
Telephone Number : 800-555-9073
Fax Number : 972-367-3452
Provider Business Practice Location Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-248-1809
Fax Number : 972-367-3452
Authorized Official
Title or Position : AGENT
Name : MOUZON BASS III
Credential :
Telephone Number : 972-367-4845
Provider Enumeration Date : 07/14/2015
Last Update Date : 07/14/2015

Similar Medicare Providers

1770547861 — PROF. JASON P BENNETT ATC
Practice Location Address:
1100 NORTH AVENUE , COLORADO MESA UNIVERSITY
GRAND JUNCTION, CO
81501-3122
Practice Phone: 970-248-1194
Practice Fax:
1861411415 — DR. JEREMY HAWKINS PHD, ATC, LAT
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1801124615 — EMILY SUSAN NEMETH LPC, CADC-I
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1100 NORTH AVE
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Practice Fax:
1740551456 — MISS SHANNON LEAH HATTERVIG ATC
Practice Location Address:
1100 NORTH AVE
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Practice Fax:
1558632232 — JOSHUA FULLMER MS, ATC
Practice Location Address:
1100 NORTH AVE
GRAND JUNCTION, CO
81501-3122
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1942698642 — MISS REH LYNN VANATTA
Practice Location Address:
1100 NORTH AVE
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Directions to “COLORADO MESA UNIVERSITY ” Practice Location

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