Basic Information
| Provider Information | |||||||||
| NPI: | 1972111953 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY-WIDE HEALTH SYSTEMS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY-WIDE BUENA VISTA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | ALAMOSA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811012290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195895161 | ||||||||
| FaxNumber: | 7195871532 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 US HIGHWAY 24 N | ||||||||
| Address2: | |||||||||
| City: | BUENA VISTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812119863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193958610 | ||||||||
| FaxNumber: | 7193955745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2020 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARNOLDI | ||||||||
| AuthorizedOfficialFirstName: | JANIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDNET/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7195895161 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.