Provider Demographics
NPI:1447539861
Name:VAIL VALLEY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:VAIL VALLEY SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-477-8210
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-1270
Mailing Address - Country:US
Mailing Address - Phone:970-476-8872
Mailing Address - Fax:970-477-8215
Practice Address - Street 1:320 BEARD CREEK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-476-8872
Practice Address - Fax:970-477-8215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAIL VALLEY SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical