Boulder Plastic Surgery Prof LLC
Organization Active NPI Specialist · Longmont, CO
NPI 1114513009 · NPPES record last updated Dec 15, 2020
Key facts
- NPI
- 1114513009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- BOULDER PLASTIC SURGERY PROF LLC
- Practice address
- 1750 E Ken Pratt Blvd
Longmont, CO 80504-5311 - Phone
- (720) 718-7000
- NPI assigned
- Dec 15, 2020
- Organization subpart
- No
Authorized official
- Name
- Pam Garcia
- Title
- Office Contact
- Phone
- (303) 443-2277
Other NPIs on the same Medicare enrollment 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040302000408 | CO | Part B Supplier - Clinic/Group Practice | 0941197248 |
Receives reassigned benefits from 3 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boulder, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
1750 E Ken Pratt Blvd
Longmont, CO 80504-5311
Mailing address
PO Box 7643
Loveland, CO 80537-0643
Phone (970) 663-2742
Other providers in Longmont, CO
- Boulder Community Health
- Boulder Community Health
- Boulder County Public Health
- Boulder County Public Health
- Boulder Medical Center, P.C.
- Boulder Plastic Surgery Prof LLC
- Boulder Twilight Inc
- Boulder Valley Gastroenterology Inc.
- Boulder Valley Thoracic and Cardiovascular Surgery
- Boulder Valley Women'S Health Center, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.