Healthcare Provider Details

I. General information

NPI: 1164077897
Provider Name (Legal Business Name): VAIL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SYLVAN LAKE RD STE 100
EAGLE CO
81631-6779
US

IV. Provider business mailing address

PO BOX 840220
KANSAS CITY MO
64184-0220
US

V. Phone/Fax

Practice location:
  • Phone: 970-328-6715
  • Fax:
Mailing address:
  • Phone: 970-777-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
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