Provider Demographics
NPI:1114673415
Name:VAIL CLINIC, INC.
Entity Type:Organization
Organization Name:VAIL CLINIC, INC.
Other - Org Name:HOWARD HEAD SPORTS MEDICINE AT EDWARDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-479-7272
Mailing Address - Street 1:PO BOX 840220
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-0220
Mailing Address - Country:US
Mailing Address - Phone:970-777-2850
Mailing Address - Fax:
Practice Address - Street 1:320 BEARD CREEK RD STE 1100
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6433
Practice Address - Country:US
Practice Address - Phone:970-476-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAIL CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center