Medical Staff Services

The Medical Staff Office at Montrose Memorial Hospital is located on the first floor of the facility near the Acute Rehabilitation Unit and around the corner from the Doctor’s Lounge.  The office is staffed Monday-Friday 8:00 a.m. – 5:00 p.m.  You can reach the Medical Staff Services Office by telephone at (970) 240-7394 or (970) 240-7249, or by fax at (970) 252-2619. 

Application for Medical Staff - Credentialing Documents

Colorado Health Care Professional Credentials Application 2014Supplemental Information   Form
Applicant ChecklistStaff Status Request Form
Background FormStatement of Notice to Physicians 
Release of Liability Cafe Deduct Form
Evidence of Infectious Disease ImmunityFluoroscopy Education and Training for Physicians
HIPAA FormsIntended Practice Plan
Physician Signature FormProvider Security Agreement
Physician Directory Information SheetCOPIC Release Form
Military Request for DD214





Initial application fees at Montrose Memorial Hospital are $350.00, which includes two years’ registration for our Annual Fall Clinics Conference and all other CME activities click here.  Reappointment fees are $300 (every two years) and cover two years’ registration at Fall Clinics and all other CME activities. 

Initial Appointment 

$350




Reappointment

$300




Advanced Professional Practitioner

$150





Continuing Medical Education is also part of the responsibilities of the Medical Staff Services personnel. In addition, the Physician Referral Line is answered by the Medical Staff Services staff.  If you have questions regarding services offered at MMH, please contact the numbers listed above. 

Contacts:

Medical Staff Services:
Michael Benziger, MD and Michael Brezinsky, MD - Directors for Continuing Medical Education
Contact:  Julie Disher, 970.240.7394
jdisher@montrosehospital.com
 
Chief of Staff:
David Dreitlein, MD
Contact:  Julie Disher, 970.240.7394
jdisher@montrosehospital.com