=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013982339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAIL CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 BEARD CREEK ROAD
-----------------------------------------------------
City | EDWARDS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-569-7455
-----------------------------------------------------
Fax | 970-569-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40000
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81658-7520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-569-7455
-----------------------------------------------------
Fax | 970-569-7454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER INSURANCE CONTRACTING
-----------------------------------------------------
Name | MRS. MARKEY BUTLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-569-7456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------