Provider Demographics
NPI:1588780886
Name:GUNNISON VALLEY FAMILY PHYSICIANS
Entity type:Organization
Organization Name:GUNNISON VALLEY FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURETTA
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-641-0211
Mailing Address - Street 1:130 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2246
Mailing Address - Country:US
Mailing Address - Phone:970-641-0211
Mailing Address - Fax:970-641-1268
Practice Address - Street 1:130 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2246
Practice Address - Country:US
Practice Address - Phone:970-641-0211
Practice Address - Fax:970-641-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04895082Medicaid
CO04895082Medicaid