Healthcare Provider Details

I. General information

NPI: 1649449075
Provider Name (Legal Business Name): ARKANSAS VALLEY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CARSON
LA JUNTA CO
81050-2751
US

IV. Provider business mailing address

1100 CARSON
LA JUNTA CO
81050-2751
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-6390
  • Fax: 719-383-5140
Mailing address:
  • Phone: 719-383-6390
  • Fax: 719-383-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04102042
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
IdentifierAR240008
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerBLUE CROSS
# 3
IdentifierCJ5303
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier24982571
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: AARON BRENT CROWELL
Title or Position: PHYSICIAN CLINIC DIRECTOR
Credential:
Phone: 719-383-6390