Provider Demographics
NPI:1578997284
Name:GUNNISON VALLEY HOSPITAL
Entity Type:Organization
Organization Name:GUNNISON VALLEY HOSPITAL
Other - Org Name:GUNNISON VALLEY HEALTH FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERVEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-642-4760
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2243
Mailing Address - Country:US
Mailing Address - Phone:970-641-7231
Mailing Address - Fax:
Practice Address - Street 1:707 N IOWA ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2229
Practice Address - Country:US
Practice Address - Phone:970-642-8413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNNISON VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-29
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04003224Medicaid
CO04003224Medicaid