Provider Demographics
NPI:1285017673
Name:BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC
Entity Type:Organization
Organization Name:BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC
Other - Org Name:BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-415-7433
Mailing Address - Street 1:PO BOX 9019
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9019
Mailing Address - Country:US
Mailing Address - Phone:303-938-3295
Mailing Address - Fax:303-440-2435
Practice Address - Street 1:2150 STADIUM DR FL 2
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0380
Practice Address - Country:US
Practice Address - Phone:303-315-9901
Practice Address - Fax:303-315-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology