Basic Information
| Provider Information | |||||||||
| NPI: | 1528606316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULDER COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4747 ARAPAHOE AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154700 | ||||||||
| FaxNumber: | 3034154701 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 ERIE PKWY | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805164070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034422395 | ||||||||
| FaxNumber: | 3034421073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2019 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | MUNSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/V.P. FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7208547433 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BOULDER COMMUNITY HEALTH | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.