| Boulder Valley Iom, Llc | |
|
3492 W 155th Ave Broomfield CO 80023-4100 | |
| (202) 316-9902 | |
| (303) 302-1591 |
| Full Name | Boulder Valley Iom, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3492 W 155th Ave, Broomfield, Colorado |
| Authorized Official Name and Position | Alexandra Lewis (ONWER) |
| Authorized Official Contact | 2023169902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulder Valley Iom, Llc 5023 W 120th Ave Po Box 236 Broomfield CO 80020-5606 Ph: (303) 803-4004 | Boulder Valley Iom, Llc 3492 W 155th Ave Broomfield CO 80023-4100 Ph: (202) 316-9902 |
| NPI Number | 1316464076 |
|---|---|
| Provider Enumeration Date | 08/24/2017 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316464076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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