Healthcare Provider Details

I. General information

NPI: 1730735531
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: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUPERIOR DR STE 100A
SUPERIOR CO
80027-8653
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-5255
  • Fax: 303-415-5256
Mailing address:
  • Phone: 303-415-5255
  • Fax: 303-415-5256

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: 303-415-8800