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General NPI Number Information
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NPI Number | 1164048161
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Entity Type | Organization
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Legal Business Name | CROSSROADS MEDICAL CENTER
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 2760 29TH ST STE 2B
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City | BOULDER
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State | CO
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Zip | 80301-1221
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Country | US
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Telephone | 303-444-6400
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Fax | 303-444-6465
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Provider Business Mailing Address
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Address Line | 2760 29TH ST STE 2B
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City | BOULDER
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State | CO
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Zip | 80301-1221
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Country | US
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Telephone | 303-444-6400
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Fax | 303-444-6465
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MS. LAUREN JASILLI
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Credential | FNP-C
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Telephone | 303-444-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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