MEDICARE: COLORADO SURGICAL AFFILIATES, LLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1720744568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SURGICAL AFFILIATES, LLC

Provider Business Mailing Address
First Line	:	2373 G RD STE 200
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-3061
Fax Number	:	970-245-8369

Provider Business Practice Location Address
First Line	:	2373 G RD STE 200
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-3061
Fax Number	:	970-245-8369

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	JACQUELINE S NESTLE
Credential	:
Telephone Number	:	970-244-5945

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	05/11/2026

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Practice Location Address:

2373 G RD STE 200
GRAND JUNCTION, CO
81505-1006

Practice Phone: 970-243-3061
Practice Fax: 970-245-8369

1467958264 — MICHAEL F ATWELL MD
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1154361046 — DR. BRADLEY ALAN BALDWIN DO
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1538458575 — NICHOLAS JAMES WESTFALL M.D.
Practice Location Address:

2373 G RD STE 200
GRAND JUNCTION, CO
81505-1006

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1689098295 — COMMUNITY MEDICAL GROUP
Practice Location Address:

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1508284506 — TIMOTHY VANADURONGVAN M.D.
Practice Location Address:

2373 G RD STE 200
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