Organization
VVMC DIVERSIFIED SERVICES
Active
Parent organization
VAIL CLINIC INC.
Other names
Northstar Urology
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAIL CLINIC INC.
Authorized official
MR. CHARLES W CREVLING (CFO)
(970) 479-7238
Entity
Organization
Contact information
Practice address
320 BEARD CREEK ROAD, EDWARDS, CO 81632
(970) 569-7725
Mailing address
PO BOX 848997, BOSTON, MA 02284-8997
(970) 777-2834
(970) 777-2929
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0786
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01926721
—
CO
Enumeration date
10/13/2006
Last updated
04/27/2009
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