Healthcare Provider Details

I. General information

NPI: 1235308982
Provider Name (Legal Business Name): BOULDER INSTITUTE FOR SPORTS MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CENTER GREEN DR SUITE 150
BOULDER CO
80301-2364
US

IV. Provider business mailing address

3000 CENTER GREEN DR SUITE 150
BOULDER CO
80301-2364
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-8807
  • Fax: 303-247-1232
Mailing address:
  • Phone: 303-449-8807
  • Fax: 303-247-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number34682
License Number StateCO

VIII. Authorized Official

Name: DR. JOANNE HALBRECHT
Title or Position: OWNER
Credential: M.D.
Phone: 303-449-8807