Healthcare Provider Details

I. General information

NPI: 1578997284
Provider Name (Legal Business Name): GUNNISON VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N IOWA ST
GUNNISON CO
81230-2229
US

IV. Provider business mailing address

711 N TAYLOR ST
GUNNISON CO
81230-2243
US

V. Phone/Fax

Practice location:
  • Phone: 970-642-8413
  • Fax:
Mailing address:
  • Phone: 970-641-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK VANDERVEER
Title or Position: CFO
Credential:
Phone: 970-642-4760