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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