Healthcare Provider Details

I. General information

NPI: 1790980480
Provider Name (Legal Business Name): J K HULLETT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 RIVERBEND RD SUITE B
BOULDER CO
80301-2640
US

IV. Provider business mailing address

4895 RIVERBEND RD SUITE B
BOULDER CO
80301-2640
US

V. Phone/Fax

Practice location:
  • Phone: 303-786-9200
  • Fax: 303-786-9300
Mailing address:
  • Phone: 303-786-9200
  • Fax: 303-786-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIMBERLY WARNER HULLETT
Title or Position: PRESIDENT
Credential:
Phone: 303-786-9200