Healthcare Provider Details

I. General information

NPI: 1043379621
Provider Name (Legal Business Name): GARY VINT YORK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 FERNBROOK DR
LOVELAND CO
80538-9412
US

IV. Provider business mailing address

4212 FERNBROOK DR
LOVELAND CO
80538-9412
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-0133
  • Fax: 970-663-1153
Mailing address:
  • Phone: 970-663-0133
  • Fax: 970-663-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: