Provider Demographics
NPI:1457493660
Name:BOULDER VALLEY NEURLOGY INC
Entity Type:Organization
Organization Name:BOULDER VALLEY NEURLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-926-1015
Mailing Address - Street 1:1044 S 88TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9417
Mailing Address - Country:US
Mailing Address - Phone:303-926-1015
Mailing Address - Fax:303-926-1032
Practice Address - Street 1:1044 S 88TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9417
Practice Address - Country:US
Practice Address - Phone:303-926-1015
Practice Address - Fax:303-926-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO425282084N0008X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21333858Medicaid
CODF8108OtherRAIL ROAD MEDICARE
COC808346Medicare PIN
COC808347Medicare PIN