Provider Demographics
NPI:1013026376
Name:COLORADO CARDIOVASCULAR CENTER
Entity Type:Organization
Organization Name:COLORADO CARDIOVASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-544-1200
Mailing Address - Street 1:3000 CENTER GREEN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2364
Mailing Address - Country:US
Mailing Address - Phone:303-544-1200
Mailing Address - Fax:303-544-0086
Practice Address - Street 1:3000 CENTER GREEN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-544-1200
Practice Address - Fax:303-544-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71026371Medicaid
CO71026371Medicaid