Provider Demographics
NPI:1942510169
Name:EPSTEIN NEUROSURGERY CENTER, LLC
Entity Type:Organization
Organization Name:EPSTEIN NEUROSURGERY CENTER, LLC
Other - Org Name:BOULDER NEUROSURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FICS
Authorized Official - Phone:303-800-9129
Mailing Address - Street 1:2121 CORRAL N
Mailing Address - Street 2:
Mailing Address - City:COTOPAXI
Mailing Address - State:CO
Mailing Address - Zip Code:81223-8898
Mailing Address - Country:US
Mailing Address - Phone:303-800-9129
Mailing Address - Fax:720-638-0497
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-9468
Practice Address - Country:US
Practice Address - Phone:303-800-9129
Practice Address - Fax:720-638-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40083207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty