Provider Demographics
NPI:1043806276
Name:BOULDER VALLEY GASTROENTEROLOGY INC.
Entity Type:Organization
Organization Name:BOULDER VALLEY GASTROENTEROLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-604-5000
Mailing Address - Street 1:382 S ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11900 GRANT ST STE 360
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1117
Practice Address - Country:US
Practice Address - Phone:303-604-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER VALLEY GASTROENTEROLOGY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty