Provider Demographics
NPI:1114573938
Name:BOULDER COMMUNITY HEALTH
Entity Type:Organization
Organization Name:BOULDER COMMUNITY HEALTH
Other - Org Name:COMMUNITY MEDICAL ASSOC OF B.C.H.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP,CFO
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:303-415-7433
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:303-415-5399
Mailing Address - Fax:303-297-5808
Practice Address - Street 1:90 HEALTH PARK DR STE 130
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9586
Practice Address - Country:US
Practice Address - Phone:303-415-5399
Practice Address - Fax:303-297-5808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty