MEDICARE: VAIL CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	PDO.1470000002	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2003237	OTHER		PK

General Provider Information

NPI Number	:	1225017643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAIL CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2706
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-2706
Country	:	US
Telephone Number	:	970-569-7676
Fax Number	:	970-569-7677

Provider Business Practice Location Address
First Line	:	322 BEARD CREEK RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6426
Country	:	US
Telephone Number	:	970-569-7676
Fax Number	:	970-569-7677

Authorized Official
Title or Position	:	SVP & CFO
Name	:	MICHAEL G BROWN
Credential	:
Telephone Number	:	970-479-7272

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	01/08/2025

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Directions to “VAIL CLINIC, INC. ” Practice Location

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