Crossroads Medical Center
Family Medicine in Boulder, CO. Organization (NPI-2).
NPI number1164048161
StatusActive
Last updated in NPPESSep 27, 2024
Details
- NPI
- 1164048161
- Entity type
- Organization (NPI-2)
- Legal business name
- Crossroads Medical Center
- Organization subpart
- No
- Enumeration date
- Jun 25, 2020
- Certification date
- Sep 27, 2024
- Last updated
- Sep 27, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Carl A Mortiz Jr Mbr (Other Name)
- Crossroads Medical Center LLC (Doing Business As)
Practice location
2760 29th St Ste 2bBoulder, CO 80301-1221
Phone 303-444-6400 · Fax 303-444-6465
Mailing address
2760 29th St Ste 2bBoulder, CO 80301-1221
Phone 303-444-6400 · Fax 303-444-6465
Authorized official
Lauren Jasilli
Practice Owner
3034446400
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