Provider Demographics
NPI:1588300990
Name:VAIL INTERNATIONAL PHYSICIANS PROF LLC
Entity type:Organization
Organization Name:VAIL INTERNATIONAL PHYSICIANS PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUZICKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-330-4301
Mailing Address - Street 1:PO BOX 6380
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-6380
Mailing Address - Country:US
Mailing Address - Phone:720-441-4305
Mailing Address - Fax:877-868-0525
Practice Address - Street 1:570 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5663
Practice Address - Country:US
Practice Address - Phone:720-441-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service