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General NPI Number Information
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NPI Number | 1992236319
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Entity Type | Organization
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Legal Business Name | BOULDER CENTER FOR TMS LLC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2501 WALNUT ST SUITE 207
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City | BOULDER
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State | CO
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Zip | 80302-5751
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Country | US
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Telephone | 303-449-0318
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Fax | 303-442-1125
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Provider Business Mailing Address
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Address Line | 2501 WALNUT ST SUITE 207
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City | BOULDER
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State | CO
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Zip | 80302-5751
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Country | US
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Telephone | 303-449-0318
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Fax | 303-442-1125
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICHARD LEE SUDDATH
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Credential | M.D.
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Telephone | 303-444-7228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25131
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25705
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License Number State | CO
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