=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114886587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOULDER MEDICAL CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2026
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2750 BROADWAY ST
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80304-3586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-440-3200
-----------------------------------------------------
Fax | 303-440-3232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2750 BROADWAY ST
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80304-3586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-440-3200
-----------------------------------------------------
Fax | 303-440-3232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | CASANDRA RICHARDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-440-3076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------