1447539861 NPI number — VAIL VALLEY SURGERY CENTER, LLC

Table of content: DR. DEAN ELIAS KOIS DMD (NPI 1326166844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447539861 NPI number — VAIL VALLEY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VAIL VALLEY SURGERY CENTER, LLC
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:
1447539861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAIL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81658-1270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-476-8872
Provider Business Mailing Address Fax Number:
970-477-8215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BEARD CREEK ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EDWARDS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-476-8872
Provider Business Practice Location Address Fax Number:
970-477-8215
Provider Enumeration Date:
08/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BAXLEY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
970-477-8210

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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