Provider Demographics
NPI:1194879064
Name:COLORADO MEDICAL PSYCHIATRY, LLC
Entity type:Organization
Organization Name:COLORADO MEDICAL PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-454-1213
Mailing Address - Street 1:4770 BASELINE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2666
Mailing Address - Country:US
Mailing Address - Phone:720-304-0083
Mailing Address - Fax:720-304-0114
Practice Address - Street 1:4770 BASELINE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2666
Practice Address - Country:US
Practice Address - Phone:720-304-0083
Practice Address - Fax:720-304-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty