Healthcare Provider Details

I. General information

NPI: 1497925986
Provider Name (Legal Business Name): CCHMD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 110
BOULDER CO
80303-1082
US

IV. Provider business mailing address

4745 ARAPAHOE AVE STE 110
BOULDER CO
80303-1082
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-5110
  • Fax: 303-444-7457
Mailing address:
  • Phone: 303-444-5110
  • Fax: 303-444-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: CHRISTINE C HANSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-444-5110