| Cedaredge Doctors Office Pc | |
|
255 S Grand Mesa Dr Cedaredge CO 81413-3822 | |
| (970) 856-4111 | |
| (970) 856-4114 |
| Full Name | Cedaredge Doctors Office Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 255 S Grand Mesa Dr, Cedaredge, Colorado |
| Authorized Official Name and Position | Terry S Wade (PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 9708564111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedaredge Doctors Office Pc 255 S Grand Mesa Dr Cedaredge CO 81413-3822 Ph: (970) 856-4111 | Cedaredge Doctors Office Pc 255 S Grand Mesa Dr Cedaredge CO 81413-3822 Ph: (970) 856-4111 |
| NPI Number | 1922060656 |
|---|---|
| Provider Enumeration Date | 04/06/2006 |
| Last Update Date | 11/01/2022 |
| Medicare PECOS PAC ID | 5496738866 |
|---|---|
| Medicare Enrollment ID | O20040608001164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922060656 | NPI | - | NPPES |
| 42323797 | Medicaid | CO | |
| CE39326 | Other | CO | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Terry S Wade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346243516 PECOS PAC ID: 4688573702 Enrollment ID: I20040107000603 |
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