Basic Information
| Provider Information | |||||||||
| NPI: | 1861814097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAMPA VALLEY MEDICAL CENTER PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 E LOWRY BLVD | ||||||||
| Address2: | F402, 3RD FLOOR | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205531700 | ||||||||
| FaxNumber: | 7205531754 | ||||||||
| Practice Location | |||||||||
| Address1: | 1024 CENTRAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804878813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708701100 | ||||||||
| FaxNumber: | 9708712315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | RIEBER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | UCHEALTH CFO | ||||||||
| AuthorizedOfficialTelephone: | 7208487836 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 1140000003 | CO | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 05049002 | 05 | CO | MEDICAID | 0623187 | 01 | NCPDP | OTHER |