Provider Demographics
NPI:1124344080
Name:POLSLEY, CHRIS K (PA)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:K
Last Name:POLSLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2303 S TOWNSEND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5452
Mailing Address - Country:US
Mailing Address - Phone:970-249-7751
Mailing Address - Fax:970-249-5029
Practice Address - Street 1:836 S TOWNSEND AVE STE C
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4360
Practice Address - Country:US
Practice Address - Phone:970-249-2118
Practice Address - Fax:970-249-5029
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2994363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01705524OtherRAILROAD MEDICARE FOR CEDAR POINT HEALTH
CO521319ZV3YOtherMEDICARE FOR CEDAR POINT HEALTH
CO90132360Medicaid