1861496697 NPI number — LOWER VALLEY HOSPITAL ASSOCIATION

Table of content: (NPI 1861496697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861496697 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:
FAMILY HEALTH WEST HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1861496697
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:
300 W OTTLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRUITA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81521-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-858-3900
Provider Business Practice Location Address Fax Number:
970-858-2202
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  2511OC , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 0212 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X , with the licence number: AL-0277 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: AL-0444 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 0213 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04181780 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05063003 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05653712 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05659131 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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