Healthcare Provider Details

I. General information

NPI: 1780338012
Provider Name (Legal Business Name): ABIGAIL MARY PRICE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

IV. Provider business mailing address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12680501-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA.0007425
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: