# VVMC DIVERSIFIED SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VAIL CLINIC INC
- **Other names:** Eagle Care Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326222027
- **Legal business name:** VAIL CLINIC INC
- **Authorized official:** MR. CHARLES W CREVLING (CHIEF STRATEGIC OFFICER)
- **Authorized official phone:** (970) 479-7238

## Contact information

- **Practice address:** 320 BEARD CREEK ROAD, EDWARDS, CO 81632
- **Practice address phone:** (970) 569-7520
- **Practice address fax:** (970) 569-7522
- **Mailing address:** PO BOX 848997, BOSTON, MA 02284-8997
- **Mailing address phone:** (970) 777-2834
- **Mailing address fax:** (970) 777-2929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 0272 | CO | Yes |

## Other

- **Enumeration date:** 12/18/2007
- **Last updated:** 04/27/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04010757 | — | CO |