Provider Demographics
NPI:1376696500
Name:CITY OF BOULDER
Entity Type:Organization
Organization Name:CITY OF BOULDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR CITY OF BOULDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-3381
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0068
Mailing Address - Country:US
Mailing Address - Phone:406-225-3381
Mailing Address - Fax:406-225-9498
Practice Address - Street 1:205 W SECOND AVE
Practice Address - Street 2:AMBULANCE BARN
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-0068
Practice Address - Country:US
Practice Address - Phone:406-225-3381
Practice Address - Fax:406-225-9498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BOULDER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT448864Medicaid
MT448864Medicaid
MT000002259Medicare UPIN