Healthcare Provider Details

I. General information

NPI: 1871183707
Provider Name (Legal Business Name): VVMC DIVERSIFIED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR STE 2400
VAIL CO
81657-5242
US

IV. Provider business mailing address

PO BOX 841152
KANSAS CITY MO
64184-1152
US

V. Phone/Fax

Practice location:
  • Phone: 970-479-5036
  • Fax:
Mailing address:
  • Phone: 970-777-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G BROWN
Title or Position: SVP & CFO
Credential:
Phone: 970-479-7272