Provider Demographics
NPI:1407187636
Name:WISDOM HEALTH PC
Entity type:Organization
Organization Name:WISDOM HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-938-1110
Mailing Address - Street 1:2950 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2720
Mailing Address - Country:US
Mailing Address - Phone:303-938-1110
Mailing Address - Fax:
Practice Address - Street 1:2919 VALMONT RD STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1350
Practice Address - Country:US
Practice Address - Phone:303-938-1110
Practice Address - Fax:303-938-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08025Medicare UPIN
COC517398Medicare PIN