Provider Demographics
NPI:1073393807
Name:BOULDER COMMUNITY HEALTH
Entity Type:Organization
Organization Name:BOULDER COMMUNITY HEALTH
Other - Org Name:COMMUNITY MEDICAL ASSOC OF BCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CFP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-485-7433
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4101
Mailing Address - Fax:
Practice Address - Street 1:2101 KEN PRATT BLVD STE 104G
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6568
Practice Address - Country:US
Practice Address - Phone:303-415-4246
Practice Address - Fax:303-415-8407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care