Healthcare Provider Details

I. General information

NPI: 1851449920
Provider Name (Legal Business Name): VAIL MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0105 EDWARDS VILLAGE CENTER A203
EDWARDS CO
81632
US

IV. Provider business mailing address

PO BOX 2637
EDWARDS CO
81632-2637
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-4600
  • Fax: 970-926-4602
Mailing address:
  • Phone: 970-926-4600
  • Fax: 970-926-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4030
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11122
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL T DEKANICH
Title or Position: PRESIDENT
Credential: DC, DACBSP, EMT,CSCS
Phone: 970-926-4600