NPIMap

Organization Active NPI

Intermountain Medical Group Grand Junction, LLC

  • Internal Medicine Physician
  • Grand Junction, CO
National Provider Identifier
1104430974
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC
Practice address
2635 N 7TH St
Entrance 4
Grand Junction, CO 81501-8209
Phone
(970) 298-6307
Fax
(970) 298-7037
NPI assigned
Aug 31, 2020
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jon McDaniel
Title
VP Finance Medical Group
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2635 N 7TH St
Entrance 4
Grand Junction, CO 81501-8209

Mailing address

2635 N 7TH St
Entrance 4
Grand Junction, CO 81501-8209
Phone (970) 298-6307

Other names 1

  • St Mary's Regional Hospital Wound Care Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Med GRP Grand44 organizations share this tax ID, including this one
Part of
Lutheran Medical Center

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

2635 N 7th St
#4
Grand Junction, CO 81501
Phone (970) 298-7106

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1104430974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 N 7TH ST",
            "address_2": "ENTRANCE 4",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018209",
            "telephone_number": "970-298-6307",
            "fax_number": "970-298-7037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 N 7TH ST",
            "address_2": "ENTRANCE 4",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018209",
            "telephone_number": "970-298-6307",
            "fax_number": "970-298-7037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2020-08-31",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE MEDICAL GROUP",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Mary's Regional Hospital Wound Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.