Provider Demographics
NPI:1316330368
Name:GREEN MOUNTAIN PARTNERS FOR HEALTH PLLC
Entity type:Organization
Organization Name:GREEN MOUNTAIN PARTNERS FOR HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-566-7170
Mailing Address - Street 1:200 UNION
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1831
Mailing Address - Country:US
Mailing Address - Phone:303-566-7170
Mailing Address - Fax:303-566-7172
Practice Address - Street 1:200 UNION BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1830
Practice Address - Country:US
Practice Address - Phone:303-566-7170
Practice Address - Fax:303-566-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0050120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36987263Medicaid