Healthcare Provider Details

I. General information

NPI: 1174581433
Provider Name (Legal Business Name): BOULDER EKG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3464 S WILLOW ST
DENVER CO
80231-4531
US

IV. Provider business mailing address

1100 BALSAM AVE
BOULDER CO
80304-3404
US

V. Phone/Fax

Practice location:
  • Phone: 303-755-2900
  • Fax: 303-755-0404
Mailing address:
  • Phone: 303-440-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC ZACHARIAS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 303-440-3083