Provider Demographics
NPI:1184685323
Name:BOATNER, MARGO C (PAC)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:C
Last Name:BOATNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:MARGO
Other - Middle Name:C
Other - Last Name:COLLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:STE 280
Mailing Address - City:STEAMBOAT SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-879-6663
Mailing Address - Fax:
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:STE 280
Practice Address - City:STEAMBOAT SPGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72436069Medicaid
2180OtherCOLORADO STATE LICENSE
MC1343879OtherDEA COLORADO