# FOUR MILE CREEK HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225854425
- **Authorized official:** RADFORD FAGAN (VICE PRESIDENT)
- **Authorized official phone:** (720) 792-2852

## Contact information

- **Practice address:** 3434 47TH ST STE 225, BOULDER, CO 80301-1880
- **Practice address phone:** (703) 850-1533
- **Practice address fax:** (303) 586-7592
- **Mailing address:** 3434 47TH ST STE 225, BOULDER, CO 80301-1880
- **Mailing address phone:** (703) 850-1533

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2024
- **Last updated:** 12/03/2024