Basic Information
| Provider Information | |||||||||
| NPI: | 1578997284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUNNISON VALLEY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GUNNISON VALLEY HEALTH FAMILY MEDICINE CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706417231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 707 N IOWA ST | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706428413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | VANDERVEER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9706424760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GUNNISON VALLEY HOSPITAL | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.