Healthcare Provider Details

I. General information

NPI: 1174179964
Provider Name (Legal Business Name): BOULDER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ERIE PKWY STE 101
ERIE CO
80516-4071
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-5810
  • Fax: 303-415-5820
Mailing address:
  • Phone: 303-415-5810
  • Fax: 303-415-5820

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: WILLIAM A MUNSON JR.
Title or Position: VP,CFO
Credential:
Phone: 303-415-7433