Healthcare Provider Details

I. General information

NPI: 1114778412
Provider Name (Legal Business Name): ASPEN VALLEY HOSPITAL DISTRICT CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E VALLEY RD STE 103
BASALT CO
81621-8412
US

IV. Provider business mailing address

401 CASTLE CREEK RD OFC
ASPEN CO
81611-1159
US

V. Phone/Fax

Practice location:
  • Phone: 970-544-1200
  • Fax:
Mailing address:
  • Phone: 970-544-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID BRAIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 709-544-7382