MEDICARE: COLORADO WEST HEALTHCARESYSTEM, INC

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	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1922423995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO WEST HEALTHCARESYSTEM, INC

Provider Business Mailing Address
First Line	:	2004 N 12TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2982
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 N 12TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2982
Country	:	US
Telephone Number	:	970-263-2600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	CHRISTIAN THOMAS
Credential	:
Telephone Number	:	970-256-6200

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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