Healthcare Provider Details

I. General information

NPI: 1902270440
Provider Name (Legal Business Name): LOWER VALLEY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 KOKOPELLI BLVD UNIT F
FRUITA CO
81521-6305
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2585
  • Fax: 970-858-2555
Mailing address:
  • Phone: 970-858-2186
  • Fax: 970-858-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0030888
License Number StateCO

VIII. Authorized Official

Name: KORREY KLEIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 970-858-2164