Active NPI
Vail Clinic, Inc.
- Clinic Pharmacy
- Edwards, CO
National Provider Identifier
1225017643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic Pharmacy
- License
- PDO.1470000002
- Legal business name
- VAIL CLINIC, INC.
- Practice address
- 322 Beard Creek Rd
Edwards, CO 81632-6426 - Phone
- (970) 569-7676
- Fax
- (970) 569-7677
- NPI assigned
- Jan 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael G Brown
- Title
- SVP & Cfo
- Phone
- (970) 479-7272
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic Pharmacy | 3336C0002X | PDO.1470000002 | CO | Primary |
Addresses
Primary practice location
322 Beard Creek Rd
Edwards, CO 81632-6426
Mailing address
PO Box 2706
Edwards, CO 81632-2706
Phone (970) 569-7676
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03003720 | Medicaid | CO | |
| 2003237 | Other | PK |
Other names 2
- Edwards Medical Center Pharmacy
- Vail Health Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131207000064 | CO | Part B Supplier - Mass Immunization (Roster Biller Only) | 3577475714 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Edwards, CO; Vail, CO |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1736294400000",
"number": "1225017643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2706",
"city": "EDWARDS",
"state": "CO",
"postal_code": "816322706",
"telephone_number": "970-569-7676",
"fax_number": "970-569-7677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 BEARD CREEK RD",
"city": "EDWARDS",
"state": "CO",
"postal_code": "816326426",
"telephone_number": "970-569-7676",
"fax_number": "970-569-7677"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VAIL CLINIC, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-13",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A",
"authorized_official_last_name": "BROWN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "SVP & CFO",
"authorized_official_telephone_number": "970-479-7272"
},
"taxonomies": [
{
"code": "3336C0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Clinic Pharmacy",
"state": "CO",
"license": "PDO.1470000002",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03003720",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2003237",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Edwards Medical Center Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Vail Health Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Edwards, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.