Provider Demographics
NPI:1548911373
Name:GRAND VALLEY ORTHOPEDICS
Entity type:Organization
Organization Name:GRAND VALLEY ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-263-2619
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-245-0484
Mailing Address - Fax:970-241-1681
Practice Address - Street 1:2373 G RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81505-1003
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-241-1681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAND VALLEY ORTHOPEDICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies