Healthcare Provider Details

I. General information

NPI: 1205246444
Provider Name (Legal Business Name): VIDSTONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5485 S AUTUMN CT
GREENWOOD VILLAGE CO
80111-3417
US

IV. Provider business mailing address

5485 S AUTUMN CT
GREENWOOD VILLAGE CO
80111-3417
US

V. Phone/Fax

Practice location:
  • Phone: 303-500-1820
  • Fax: 303-732-6466
Mailing address:
  • Phone: 303-500-1820
  • Fax: 303-732-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: S AGUIRRE
Title or Position: MANAGING MEMBER
Credential:
Phone: 303-500-1820