# INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM
- **Other names:** St Mary's Medical Group, Intermountain Medical Group Grand Junction, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356765556
- **Legal business name:** SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM
- **Authorized official:** MR. JON MCDANIEL (VP FINANCE)
- **Authorized official phone:** (303) 272-0231

## Contact information

- **Practice address:** 2635 N 7TH ST, GRAND JUNCTION, CO 81501
- **Practice address phone:** (970) 298-2273
- **Practice address fax:** (970) 298-1809
- **Mailing address:** 2635 N 7TH ST, GRAND JUNCTION, CO 81501-8209
- **Mailing address phone:** (970) 298-2273
- **Mailing address fax:** (970) 298-1809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 207RN0300X | Nephrology Physician | — | NULL | — |
| 207RN0300X | Nephrology Physician | — | — | — |
| 207T00000X | Neurological Surgery Physician | — | NULL | — |
| 207T00000X | Neurological Surgery Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | CO | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 2080P0202X | Pediatric Cardiology Physician | — | NULL | — |
| 2080P0202X | Pediatric Cardiology Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208200000X | Plastic Surgery Physician | — | NULL | — |
| 208200000X | Plastic Surgery Physician | — | — | — |
| 2083X0100X | Occupational Medicine Physician | — | NULL | — |
| 2083X0100X | Occupational Medicine Physician | — | — | — |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | — |
| 2086S0120X | Pediatric Surgery Physician | — | — | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 02/07/2014
- **Last updated:** 06/28/2024