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Boulder Community Health Sports Medicine Imaging LLC

Organization Active NPI Radiology Clinic/Center · Boulder, CO

NPI 1285017673 · NPPES record last updated Aug 6, 2015

Key facts

NPI
1285017673
Entity type
Organization (NPI type 2)
Primary specialty
Radiology Clinic/Center 261QR0200X
Legal business name
BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC
Practice address
2150 Stadium Dr FL 2
Suite 100
Boulder, CO 80309-0380
Phone
(303) 315-9901
Fax
(303) 315-9902
NPI assigned
Jul 2, 2015
Organization subpart
No

Authorized official

Name
Mr. William Munson
Title
V.P. and Chief Financial Officer
Phone
(303) 415-7433

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 24

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20151120000903 CO Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9830499003 Practice locations: Boulder, CO

National Provider Directory

Locations

2150 Stadium Dr
Fl 2
Boulder, CO 80309
Phone (303) 315-9900

2150 Stadium Dr Fl2
Ste 100
Boulder, CO 80309

2150 Stadium Dr 2nd
Boulder, CO 80309
Phone (303) 315-9900

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Yes

Addresses

Primary practice location

2150 Stadium Dr FL 2
Suite 100
Boulder, CO 80309-0380

Mailing address

PO Box 9019
Boulder, CO 80301-9019
Phone (303) 938-3295

Other names

  • Boulder Community Health Sports Medicine Imaging LLC Doing business as

Other providers in Boulder, CO

All providers in Boulder, CO · Radiology Clinic/Center in Colorado

Sources for this page

Verify at the official NPI Registry.