Traverse Bay Medical, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TRAVERSE BAY MEDICAL, PC

Practice address

1815 Sunshine Ave
Longmont, CO 80504-2225

Phone

(303) 722-9000

NPI assigned

May 11, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Louise Louder, D.O

Title

Owner

Phone

(303) 722-9000

Specialties & licenses 1

Addresses

Other names 1

• Colorado Integrative Medical Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carolyn Franklin Baker, RN

  • Registered Nurse
  • Longmont, CO
  • NPI 1548616154
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470009600000",
    "number": "1124474945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 PARK LN STE 101-B",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800263200",
            "telephone_number": "303-722-9000",
            "fax_number": "844-800-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SUNSHINE AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805042225",
            "telephone_number": "303-722-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE BAY MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-11",
        "last_updated": "2016-08-01",
        "status": "A",
        "authorized_official_last_name": "LOUDER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-722-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Integrative Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Longmont, CO
• Providers in Longmont, CO by specialty
• Primary Care Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.