Healthcare Provider Details

I. General information

NPI: 1497329643
Provider Name (Legal Business Name): VVMC DIVERSIFIED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 DILLON RIDGE RD STE 1100
DILLON CO
80435-6344
US

IV. Provider business mailing address

PO BOX 841152
KANSAS CITY MO
64184-1150
US

V. Phone/Fax

Practice location:
  • Phone: 970-479-7272
  • Fax:
Mailing address:
  • Phone: 970-777-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G BROWN
Title or Position: SVP & CFO
Credential:
Phone: 970-479-7272