Provider Demographics
NPI:1992315279
Name:GUNNISON VALLEY FAMILY PHYSICIANS CRESTED BUTTE
Entity type:Organization
Organization Name:GUNNISON VALLEY FAMILY PHYSICIANS CRESTED BUTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH
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:
Practice Address - Street 1:214 6TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-6749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNNISON VALLEY FAMILY PHYSICIANS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care