1215535943 NPI number — LOWER VALLEY HOSPITAL ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215535943 NPI number — LOWER VALLEY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER VALLEY HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215535943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRUITA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81521-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-858-2186
Provider Business Mailing Address Fax Number:
970-858-2208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 KOKOPELLI BLVD UNIT F
Provider Second Line Business Practice Location Address:
-PRACTICE LOCATION NPI ONLY-
Provider Business Practice Location Address City Name:
FRUITA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-858-2589
Provider Business Practice Location Address Fax Number:
970-858-9179
Provider Enumeration Date:
10/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
KORREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
970-858-2164

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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