Grand Mesa Medical Supply, LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

GRAND MESA MEDICAL SUPPLY, LLC

Practice address

1708 North Ave
Grand Junction, CO 81501-6423

Phone

(970) 241-0833

Fax

(970) 241-2663

NPI assigned

Jun 9, 2005

Organization subpart

No

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

Authorized official

Name

Constance R Johnson

Title

Owner

Phone

(970) 241-0833

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1841294519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 NORTH AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815016423",
            "telephone_number": "970-241-0833",
            "fax_number": "970-241-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 NORTH AVE",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815016423",
            "telephone_number": "970-241-0833",
            "fax_number": "970-241-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND MESA MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-241-0833"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78024811",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Grand Mesa Counseling LLC
• Grand Mesa Nephrology PLLC
• Grand Mesa Spine and Sport LLC
• Grand Mesa Spine and Sport, LLC
• Grand Mesa Spine and Sport, LLC
• Grand River Psychiatry PLLC

• Customized Equipment (DME) in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Customized Equipment (DME) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.