Provider Demographics
NPI:1336148360
Name:BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER, LLC
Entity type:Organization
Organization Name:BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-359-2107
Mailing Address - Street 1:PO BOX 18058
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1058
Mailing Address - Country:US
Mailing Address - Phone:303-938-5470
Mailing Address - Fax:303-938-5493
Practice Address - Street 1:4740 PEARL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3082
Practice Address - Country:US
Practice Address - Phone:303-938-5470
Practice Address - Fax:303-938-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0119261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801692Medicare ID - Type Unspecified