Provider Demographics
NPI:1871982215
Name:CHAY JAY LLC
Entity type:Organization
Organization Name:CHAY JAY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-216-6199
Mailing Address - Street 1:569 32 RD STE 12
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6095
Mailing Address - Country:US
Mailing Address - Phone:970-523-3544
Mailing Address - Fax:970-434-3422
Practice Address - Street 1:569 32 RD
Practice Address - Street 2:UNIT 12
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-7053
Practice Address - Country:US
Practice Address - Phone:970-523-3544
Practice Address - Fax:970-434-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty