Provider Demographics
NPI:1649449075
Name:ARKANSAS VALLEY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ARKANSAS VALLEY REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-383-6390
Mailing Address - Street 1:1100 CARSON
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2751
Mailing Address - Country:US
Mailing Address - Phone:719-383-6390
Mailing Address - Fax:719-383-5140
Practice Address - Street 1:1100 CARSON
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2751
Practice Address - Country:US
Practice Address - Phone:719-383-6390
Practice Address - Fax:719-383-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04102042Medicaid
COAR240008OtherBLUE CROSS
COCJ5303OtherRAILROAD MEDICARE
CO24982571Medicaid