Provider Demographics
NPI:1427334671
Name:BOULDER MRI, LLC
Entity type:Organization
Organization Name:BOULDER MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-440-2304
Mailing Address - Street 1:1000 W SOUTH BOULDER RD
Mailing Address - Street 2:STE: 105
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2752
Mailing Address - Country:US
Mailing Address - Phone:303-604-5031
Mailing Address - Fax:303-604-5032
Practice Address - Street 1:1000 W SOUTH BOULDER RD
Practice Address - Street 2:STE: 105
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2752
Practice Address - Country:US
Practice Address - Phone:303-604-5031
Practice Address - Fax:303-604-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)