| Awaken IV | |
|
5277 Manhattan Cir Ste 260 Boulder CO 80303-8201 | |
| (303) 409-3690 | |
| Not Available |
| Full Name | Awaken IV |
|---|---|
| Speciality | Clinic/center - Infusion Therapy |
| Location | 5277 Manhattan Cir Ste 260, Boulder, Colorado |
| Authorized Official Name and Position | Nicholas Wingo (CEO) |
| Authorized Official Contact | 7209642402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken IV 5277 Manhattan Cir Ste 260 Boulder CO 80303-8201 Ph: (720) 964-2402 | Awaken IV 5277 Manhattan Cir Ste 260 Boulder CO 80303-8201 Ph: (303) 409-3690 |
| NPI Number | 1417810631 |
|---|---|
| Provider Enumeration Date | 12/04/2025 |
| Last Update Date | 09/01/2026 |
| Certification Date | 09/01/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417810631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QI0500X | Clinic/center - Infusion Therapy | () | Primary |
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