Provider Demographics
NPI:1396986261
Name:ASPEN VALLEY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ASPEN VALLEY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:970-544-7684
Mailing Address - Street 1:234 CODY LN
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-9106
Mailing Address - Country:US
Mailing Address - Phone:970-544-1250
Mailing Address - Fax:970-544-1585
Practice Address - Street 1:234 CODY LN
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9106
Practice Address - Country:US
Practice Address - Phone:970-544-1250
Practice Address - Fax:970-544-1585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN VALLEY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-1324Medicare PIN