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 2017	Supplemental Information Form
Applicant Checklist	Staff Status Request Form
Background Form	Statement of Notice to Physicians
CO Caps Written Authorization_Form 03 19 19
Release of Liability	Cafe Deduct Form
Provider Employee Health Letter	Fluoroscopy Education and Training for Physicians
HIPAA Forms	Intended Practice Plan
Physician Signature Form	Provider Privacy & Security Orientation and Agreement
Physician Directory Information Sheet	COPIC Release Form
Military Request for DD214	Medical Staff Bylaws, Vol. 2
Medical Staff Bylaws, Vol. 1	Malpractice Release
	3rd Party Payor Enrollment Form 2018

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) for Medical Staff and $200 (every two years) for Advanced Professional Practitioners and cover two years’ registration at Fall Clinics and all other CME activities.

Initial Appointment	$350
Reappointment (Medical Staff)	$300
Reappointment (Advanced Professional Practitioner)	$200

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

For on-site Fall Clinics registration, click here.