Organization
BOULDER CARE PROVIDER GROUP PA
Active
Organization
BOULDER CARE PROVIDER GROUP PA
Active
Other names
Boulder Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PIA SHIVDASANI (VP OPERATIONS, AUTHORIZED AGENT)
(888) 288-4715
Entity
Organization
Contact information
Practice address
111 SW NAITO PKWY STE 200, PORTLAND, OR 97204-3512
(888) 316-0451
Mailing address
111 SW NAITO PKWY STE 200, PORTLAND, OR 97204-3512
(503) 208-5061
(833) 260-2594
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
06/04/2019
Last updated
06/26/2024
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