Organization
PLATEAU VALLEY HOSPITAL DISTRICT
Active
Other names
Plateau Valley Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE CLARK (ADMINISTRATOR)
(970) 487-3565
Entity
Organization
Contact information
Practice address
58128 HIGHWAY 330, COLLBRAN, CO 81624-9502
(970) 487-3565
Mailing address
58128 HIGHWAY 330, COLLBRAN, CO 81624-9502
(970) 487-3565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04703047
—
CO
05
—
04703047
—
CT
01
—
PLR3408
BLUE CROSS BLUE SHIELD
CO
Enumeration date
03/19/2007
Last updated
06/07/2022
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