Provider Demographics
NPI:1598376774
Name:BOULDER COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:BOULDER COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION & FINANC
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-441-1144
Mailing Address - Street 1:3450 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-441-1100
Mailing Address - Fax:303-441-1458
Practice Address - Street 1:515 COFFMAN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-678-6166
Practice Address - Fax:303-678-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86800094Medicaid