Healthcare Provider Details

I. General information

NPI: 1336197631
Provider Name (Legal Business Name): BOULDERCENTRE FOR ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 PEARL PKWY SUITE 200
BOULDER CO
80301-3078
US

IV. Provider business mailing address

4740 PEARL PKWY STE 200
BOULDER CO
80301-3080
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-2730
  • Fax: 303-449-5821
Mailing address:
  • Phone: 303-449-2730
  • Fax: 303-449-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: INGRID ANDERSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 303-607-6363