Healthcare Provider Details

I. General information

NPI: 1114886587
Provider Name (Legal Business Name): BOULDER MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3200
  • Fax: 303-440-3232
Mailing address:
  • Phone: 303-440-3200
  • Fax: 303-440-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASANDRA RICHARDS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 303-440-3076