Provider Demographics
NPI:1942856745
Name:BOULDER COMMUNITY HEALTH
Entity Type:Organization
Organization Name:BOULDER COMMUNITY HEALTH
Other - Org Name:SPRUCE STREET INTERNAL MEDICINE
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:303-415-3875
Mailing Address - Fax:303-449-3112
Practice Address - Street 1:2575 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3806
Practice Address - Country:US
Practice Address - Phone:303-415-3875
Practice Address - Fax:303-449-3112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care