Provider Demographics
NPI:1932109048
Name:GUNNISON VALLEY HOSPITAL
Entity Type:Organization
Organization Name:GUNNISON VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
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:970-641-1456
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2296
Mailing Address - Country:US
Mailing Address - Phone:970-641-1456
Mailing Address - Fax:970-641-4461
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2243
Practice Address - Country:US
Practice Address - Phone:970-641-1456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 261QU0200X
CO010909282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCC7482OtherMEDICARE RR
CO05070008Medicaid
COCC7482OtherMEDICARE RR
CO061320Medicare PIN
CO04030060Medicaid
CO06Z320Medicare PIN