# MOUNTAIN REVIVAL VAIL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154129815
- **Authorized official:** PAMELA SHIFRIN MT (OWNER)
- **Authorized official phone:** (978) 621-4027

## Contact information

- **Practice address:** 2211 N FRONTAGE RD W, VAIL, CO 81657-3937
- **Practice address phone:** (978) 621-4027
- **Mailing address:** 2211 N FRONTAGE RD W, VAIL, CO 81657-3937
- **Mailing address phone:** (978) 621-4027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2025
- **Last updated:** 03/06/2025