Basic Information
| Provider Information | |||||||||
| NPI: | 1548820061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTROSE MEMORIAL HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | MONTROSE PULOMNARY AT GUNNISON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707650818 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 N TAYLOR ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702522800 | ||||||||
| FaxNumber: | 9702407784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | INGRAM | ||||||||
| AuthorizedOfficialFirstName: | CHRISITNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR ANCILLARY, IT AND CLIN | ||||||||
| AuthorizedOfficialTelephone: | 9702522523 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MONTROSE MEMORIAL HOSPITAL, INC | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.