Provider Demographics
NPI:1275804890
Name:VALLEY VIEW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:VALLEY VIEW HOSPITAL ASSOCIATION
Other - Org Name:ROARING FORK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-384-6606
Mailing Address - Street 1:978 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1839
Mailing Address - Country:US
Mailing Address - Phone:970-963-3350
Mailing Address - Fax:
Practice Address - Street 1:978 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1839
Practice Address - Country:US
Practice Address - Phone:970-963-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY VIEW HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23454261Medicaid
CO23454261Medicaid
COCH2004Medicare PIN