1053082396 NPI number — MONTROSE MEMORIAL HOSPITAL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053082396 NPI number — MONTROSE MEMORIAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTROSE MEMORIAL HOSPITAL, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053082396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 S 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-249-6737
Provider Business Mailing Address Fax Number:
970-252-0112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 S. RIO GRANDE AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-249-6737
Provider Business Practice Location Address Fax Number:
970-252-0112
Provider Enumeration Date:
09/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BEAVER
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PFS ANSYLST
Authorized Official Telephone Number:
970-252-2691

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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