Provider Demographics
NPI:1710942495
Name:ASPEN VALLEY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ASPEN VALLEY HOSPITAL DISTRICT
Other - Org Name:SNOWMASS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:970-544-7684
Mailing Address - Street 1:401 CASTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1159
Mailing Address - Country:US
Mailing Address - Phone:970-544-7684
Mailing Address - Fax:970-544-1585
Practice Address - Street 1:77 WOOD ROAD
Practice Address - Street 2:SUITE N200
Practice Address - City:SNOWMASS VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:81615-1111
Practice Address - Country:US
Practice Address - Phone:970-544-1518
Practice Address - Fax:970-544-1519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN VALLEY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-1324Medicare PIN