Provider Demographics
NPI:1477221372
Name:TRAILHEAD CLINICS GLENWOOD SPRINGS
Entity Type:Organization
Organization Name:TRAILHEAD CLINICS GLENWOOD SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-404-8700
Mailing Address - Street 1:235 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3407
Mailing Address - Country:US
Mailing Address - Phone:970-644-5999
Mailing Address - Fax:970-449-7500
Practice Address - Street 1:1607 GRAND AVE UNIT 22
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3873
Practice Address - Country:US
Practice Address - Phone:970-404-8700
Practice Address - Fax:970-945-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty