Provider Demographics
NPI: | 1922655422 |
---|---|
Name: | BOULDER COMMUNITY HEALTH |
Entity Type: | Organization |
Organization Name: | BOULDER COMMUNITY HEALTH |
Other - Org Name: | BOULDER HEART LAFAYETTE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | VP,CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | MUNSON |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 303-415-7433 |
Mailing Address - Street 1: | PO BOX 9049 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOULDER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80301-9049 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-442-2395 |
Mailing Address - Fax: | 303-442-1073 |
Practice Address - Street 1: | 1000 W SOUTH BOULDER RD STE 216 |
Practice Address - Street 2: | |
Practice Address - City: | LAFAYETTE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80026-2089 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-442-2395 |
Practice Address - Fax: | 303-442-1073 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BOULDER COMMUNITY HEALTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-08-20 |
Last Update Date: | 2022-07-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |