Provider Demographics
NPI:1639767239
Name:VVMC DIVERSIFIED SERVICES
Entity Type:Organization
Organization Name:VVMC DIVERSIFIED SERVICES
Other - Org Name:VAIL HEALTH CLINIC EAGLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-479-5131
Mailing Address - Street 1:PO BOX 841152
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-1152
Mailing Address - Country:US
Mailing Address - Phone:970-777-2850
Mailing Address - Fax:
Practice Address - Street 1:377 SYLVAN LAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-6779
Practice Address - Country:US
Practice Address - Phone:970-476-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VVMC DIVERSIFIED SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-08
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty