Organization
VVMC DIVERSIFIED SERVICES
Active
Parent organization
VAIL CLINIC INC
Other names
Eagle Care Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAIL CLINIC INC
Authorized official
MR. CHARLES W CREVLING (CHIEF STRATEGIC OFFICER)
(970) 479-7238
Entity
Organization
Contact information
Practice address
320 BEARD CREEK ROAD, EDWARDS, CO 81632
(970) 569-7520
(970) 569-7522
Mailing address
PO BOX 848997, BOSTON, MA 02284-8997
(970) 777-2834
(970) 777-2929
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0272
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04010757
—
CO
Enumeration date
12/18/2007
Last updated
04/27/2009
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