Traverse Bay Medical, PC
Clinic/Center, Primary Care in Longmont, CO. Organization (NPI-2).
NPI number1124474945
StatusActive
Last updated in NPPESAug 1, 2016
Details
- NPI
- 1124474945
- Entity type
- Organization (NPI-2)
- Legal business name
- Traverse Bay Medical, PC
- Organization subpart
- No
- Enumeration date
- May 11, 2016
- Last updated
- Aug 1, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Other names
- Colorado Integrative Medical Center (Doing Business As)
Practice location
1815 Sunshine AveLongmont, CO 80504-2225
Phone 303-722-9000
Mailing address
2575 Park Ln Ste 101-BLafayette, CO 80026-3200
Phone 303-722-9000 · Fax 844-800-1478
Authorized official
Mary Louise Louder
Owner
3037229000
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