Provider Demographics
NPI:1497302749
Name:VAIL CLINIC, INC.
Entity Type:Organization
Organization Name:VAIL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-479-7272
Mailing Address - Street 1:PO BOX 40,000
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658
Mailing Address - Country:US
Mailing Address - Phone:970-479-7272
Mailing Address - Fax:
Practice Address - Street 1:410 MCGREGOR ROAD
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637
Practice Address - Country:US
Practice Address - Phone:970-476-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center