Provider Demographics
NPI:1114025673
Name:VAIL INFECTIOUS DISEASE, P.C.
Entity Type:Organization
Organization Name:VAIL INFECTIOUS DISEASE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-750-1800
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:# 270
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-750-1800
Mailing Address - Fax:303-750-8000
Practice Address - Street 1:1140 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE B105
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81658
Practice Address - Country:US
Practice Address - Phone:970-390-6631
Practice Address - Fax:303-750-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15659207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800199Medicare PIN