Organization
VAIL VALLEY EAR NOSE AND THROAT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORIE GARDNER (MANAGER)
(970) 926-6800
Entity
Organization
Contact information
Practice address
105 EDWARDS VILLAGE BLVD UNIT C202, EDWARDS, CO 81632-9914
(970) 926-6800
(970) 926-6802
Mailing address
PO BOX 1366, 105 EDWARDS VILLAGE BLVD, UNIT C202, EDWARDS, CO 81632-1366
(970) 926-6800
(970) 926-6802
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32861
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87735539
—
CO
01
—
VA657244
BCBS GROUP
CO
Enumeration date
01/31/2007
Last updated
12/18/2007
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