Provider Demographics
NPI:1740654508
Name:BOULDER VALLEY WOMEN'S HEALTH CENTER, INC.
Entity type:Organization
Organization Name:BOULDER VALLEY WOMEN'S HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-440-9320
Mailing Address - Street 1:2855 VALMONT RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1309
Mailing Address - Country:US
Mailing Address - Phone:303-440-9320
Mailing Address - Fax:303-440-8769
Practice Address - Street 1:82 21ST AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2967
Practice Address - Country:US
Practice Address - Phone:303-774-8671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER VALLEY WOMEN'S HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
390479OtherMEDICARE PTAN