Provider Demographics
NPI:1932919750
Name:BOULDER PRIMARY & URGENT CARE LLC
Entity type:Organization
Organization Name:BOULDER PRIMARY & URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-509-6028
Mailing Address - Street 1:3468 E SAHARA AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4827
Mailing Address - Country:US
Mailing Address - Phone:702-509-6028
Mailing Address - Fax:
Practice Address - Street 1:3468 E SAHARA AVE STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4827
Practice Address - Country:US
Practice Address - Phone:702-509-6028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care