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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1841899416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	4747 ARAPAHOE AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1131
Country	:	US
Telephone Number	:	303-415-4700
Fax Number	:	303-415-4701

Provider Business Practice Location Address
First Line	:	1000 W SOUTH BOULDER RD STE 216A
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2089
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:

Authorized Official
Title or Position	:	REIMBURSEMENT SPECIALIST
Name	:	JAY PEKAREK
Credential	:
Telephone Number	:	303-415-4233

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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Directions to “BOULDER COMMUNITY HEALTH ” Practice Location

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