Healthcare Provider Details

I. General information

NPI: 1467078014
Provider Name (Legal Business Name): COLORADO MOUNTAIN MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S FRONTAGE RD W STE 5800
VAIL CO
81657-5038
US

IV. Provider business mailing address

PO BOX 4330
AVON CO
81620-4330
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 970-845-2903
  • Fax: 970-926-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANE VOYTKO
Title or Position: PHYSICIAN PRESIDENT
Credential:
Phone: 970-926-6340