Provider Demographics
NPI:1295862480
Name:THE COLORADO COLLEGE BOETTCHER HEALTH CENTER
Entity Type:Organization
Organization Name:THE COLORADO COLLEGE BOETTCHER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:U
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-389-6384
Mailing Address - Street 1:1106 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2367
Mailing Address - Country:US
Mailing Address - Phone:719-389-6384
Mailing Address - Fax:719-389-6928
Practice Address - Street 1:1106 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2367
Practice Address - Country:US
Practice Address - Phone:719-389-6384
Practice Address - Fax:719-389-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBB5482637261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health