Provider Demographics
NPI:1083815203
Name:WARDENBURG HEALTH CENTER
Entity Type:Organization
Organization Name:WARDENBURG HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR OF MEDICALCLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-492-7088
Mailing Address - Street 1:UCB 119
Mailing Address - Street 2:UNIVERSITY OF COLORADO
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0119
Mailing Address - Country:US
Mailing Address - Phone:303-492-5101
Mailing Address - Fax:303-492-1747
Practice Address - Street 1:1900 WARDENBURG DRIVE UNIVERSITY OF COLORADO
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0119
Practice Address - Country:US
Practice Address - Phone:303-492-5101
Practice Address - Fax:303-492-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0301261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health