Provider Demographics
NPI:1316000169
Name:BOULDER MANAGEMENT SERVICES ORGANIZATION
Entity Type:Organization
Organization Name:BOULDER MANAGEMENT SERVICES ORGANIZATION
Other - Org Name:THE THAYER GROUP FOR WOMENS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-443-2010
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0802
Mailing Address - Country:US
Mailing Address - Phone:303-465-1303
Mailing Address - Fax:303-404-2943
Practice Address - Street 1:1155 ALPINE
Practice Address - Street 2:SUITE 230
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-443-2010
Practice Address - Fax:303-443-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27055207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44936OtherBCBS
CO21206775Medicaid
B81127Medicare UPIN
CO21206775Medicaid