Bodhi Infusion Center, LLC
Clinic/Center, Infusion Therapy in Boulder, CO. Organization (NPI-2).
NPI number1104698349
StatusActive
Last updated in NPPESJul 4, 2025
Details
- NPI
- 1104698349
- Entity type
- Organization (NPI-2)
- Legal business name
- Bodhi Infusion Center, LLC
- Organization subpart
- No
- Enumeration date
- Oct 23, 2023
- Certification date
- Jul 4, 2025
- Last updated
- Jul 4, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QI0500X | Clinic/Center, Infusion Therapy | – | – | Yes |
Practice location
2760 29th St Ste 1cBoulder, CO 80301-1221
Phone 707-256-9085
Mailing address
2760 29th St Ste 1cBoulder, CO 80301-1221
Phone 707-256-9085
Authorized official
Candace Glazier
Owner
7072569085
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