Provider Demographics
NPI:1710144159
Name:VAIL CLINIC, INC.
Entity Type:Organization
Organization Name:VAIL CLINIC, INC.
Other - Org Name:VAIL VALLEY HOME HEALTH AND MOUNTAIN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCHITA (MARKEY)
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-569-7455
Mailing Address - Street 1:PO BOX 40,000
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-7520
Mailing Address - Country:US
Mailing Address - Phone:970-569-7455
Mailing Address - Fax:970-569-7454
Practice Address - Street 1:320 BEARD CREEK ROAD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-569-7455
Practice Address - Fax:970-569-7454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAIL CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
CO17095C251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO061536Medicare Oscar/Certification
061536Medicare Oscar/Certification