Healthcare Provider Details

I. General information

NPI: 1861080475
Provider Name (Legal Business Name): VVMC DIVERSIFIED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W MAIN ST STE 101
FRISCO CO
80443-5966
US

IV. Provider business mailing address

PO BOX 40000
VAIL CO
81658-7520
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-6402
  • Fax:
Mailing address:
  • Phone: 970-479-7272
  • Fax: 970-470-6548

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 Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN D HIGGINS
Title or Position: SVP CHIEF FINANCIAL OFFICER
Credential:
Phone: 970-479-5131