Provider Demographics
NPI:1255708053
Name:VVMC DIVERSIFIED SERVICES
Entity type:Organization
Organization Name:VVMC DIVERSIFIED SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
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 40,000
Mailing Address - Street 2:C/O ADMINISTRATION
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658
Mailing Address - Country:US
Mailing Address - Phone:970-479-7272
Mailing Address - Fax:970-470-6663
Practice Address - Street 1:230 CHAPEL SQUARE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-476-2451
Practice Address - Fax:970-470-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care