Organization
GRAND MESA MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE R JOHNSON (OWNER)
(970) 241-0833
Entity
Organization
Contact information
Practice address
1708 NORTH AVE, GRAND JUNCTION, CO 81501-6423
(970) 241-0833
(970) 241-2663
Mailing address
1708 NORTH AVE, GRAND JUNCTION, CO 81501-6423
(970) 241-0833
(970) 241-2663
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78024811
—
CO
Enumeration date
06/09/2005
Last updated
02/24/2022
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