MEDICARE: BOULDER COMMUNITY HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	0909	CO
2	2084P0802X	Addiction Psychiatry Physician	0909	CO
3	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	0909	CO
4	2084P0800X	Psychiatry Physician	0909	CO

General Provider Information

NPI Number	:	1083799928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	4801 RIVERBEND RD
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2613
Country	:	US
Telephone Number	:	303-415-4299
Fax Number	:	303-441-2202

Provider Business Practice Location Address
First Line	:	4801 RIVERBEND RD
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2613
Country	:	US
Telephone Number	:	303-415-4299
Fax Number	:	303-441-2202

Authorized Official
Title or Position	:	VP, CFO
Name	:	WILLIAM A MUNSON JR.
Credential	:
Telephone Number	:	303-485-7433

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/08/2025

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Directions to “BOULDER COMMUNITY HEALTH ” Practice Location

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