Provider Demographics
NPI:1215966965
Name:WESTERN CARDIOTHORACIC ASSOCIATION, PC
Entity type:Organization
Organization Name:WESTERN CARDIOTHORACIC ASSOCIATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-242-7292
Mailing Address - Street 1:1050 WELLINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8166
Mailing Address - Country:US
Mailing Address - Phone:970-242-7292
Mailing Address - Fax:
Practice Address - Street 1:1050 WELLINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8166
Practice Address - Country:US
Practice Address - Phone:970-242-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017737Medicaid
COCS9812OtherRAILROAD MEDICARE
CO04017737Medicaid
CO04017737Medicaid