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BOULDER PLASTIC SURGERY PROF LLC
NPI 1033705926
Specialist in Boulder, CO

Active since December 15, 2020CLIA 06D2197453 · Waiver
4747 ARAPAHOE AVE, BOULDER, CO 80303(720) 854-7000 Get Directions Write a Review

NPPES record last updated: December 15, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Boulder Plastic Surgery Prof Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOULDER PLASTIC SURGERY PROF LLC (NPI 1033705926) is a healthcare organization registered as a specialist in Boulder, Colorado and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through October 25, 2026 and lists Pam Garcia, Office Contact, as its authorized official.

NPPES Registry Identity

NPI1033705926
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBOULDER PLASTIC SURGERY PROF LLC
Location Address4747 ARAPAHOE AVEBoulder, CO 80303-1131
Mailing AddressPo Box 7643Loveland, CO 80537-0643 · (970) 663-2742
Phone(720) 854-7000
Organization SubpartNo
Authorized OfficialPam GarciaOffice Contact · (303) 443-2277
Enumeration DateDecember 15, 2020
NPPES CertifiedDecember 15, 2020
✔ NPI 1033705926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4747 ARAPAHOE AVE, Boulder, CO 80303
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 06D2197453

Boulder Plastic Surgery, PLLC · Boulder, CO
Active · expires Oct 25, 2026
CLIA Number06D2197453
Laboratory TypePhysician Office
Certificate Effective DateOctober 26, 2024
Certificate Expiration DateOctober 25, 2026
Laboratory DirectorDr. Justin B. Maxhimer
Laboratory Phone(303) 443-2277
Laboratory LocationBoulder Plastic Surgery, PLLC2525 4th Street, Suite 200, Boulder, CO 80304
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELIZABETH KALEIGH JANE SMITH
Registered Nurse
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7606
ALICE AMES RDN
Dietitian, Registered
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7047
NATHAN HANTZ
Pharmacist
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7000
JEANIE JUNGBAUER
Doula
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7000
DR. KATHERINE MACCHI PHARMD
Pharmacist
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7780
VANESSA HOFMANN
Registered Nurse (General Practice)
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7000
DR. SANTIAGO DE LA GARZA M.D.
Internal Medicine
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7610
MEGAN NICOLE WINGFIELD MD
Anesthesiology
4747 ARAPAHOE AVE
BOULDER, CO 80303
Boulder County (303) 415-7000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boulder Plastic Surgery Prof LLC's NPI number?

The NPI number for Boulder Plastic Surgery Prof LLC is 1033705926. It was assigned to this organization in the NPPES registry on December 15, 2020.

Where is Boulder Plastic Surgery Prof LLC located?

Boulder Plastic Surgery Prof LLC is located at 4747 Arapahoe Ave, Boulder, CO 80303. The listed phone number is (720) 854-7000.

What is Boulder Plastic Surgery Prof LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Boulder Plastic Surgery Prof LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 06D2197453) is associated with this NPI, valid through October 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Boulder Plastic Surgery Prof LLC was last updated on December 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.