| Edenmd Wellness Llc | |
|
7760 E State Route 69 Ste C5-342 Prescott Valley AZ 86314-2201 | |
| (602) 525-8530 | |
| Not Available |
| Full Name | Edenmd Wellness Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7760 E State Route 69 Ste C5-342, Prescott Valley, Arizona |
| Authorized Official Name and Position | Ruth Forde (PHYSICIAN, PARTNER, ADMINISTRATOR) |
| Authorized Official Contact | 9566074880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edenmd Wellness Llc 6620 E Desperado Dr Prescott Valley AZ 86314-5824 Ph: (956) 607-4880 | Edenmd Wellness Llc 7760 E State Route 69 Ste C5-342 Prescott Valley AZ 86314-2201 Ph: (602) 525-8530 |
| NPI Number | 1801513114 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 11/07/2022 |
| Medicare PECOS PAC ID | 4688043995 |
|---|---|
| Medicare Enrollment ID | O20221208001781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801513114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ruth S Forde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598932345 PECOS PAC ID: 4981887734 Enrollment ID: I20190703002455 |
| Provider Name | Reynald V Forde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932269842 PECOS PAC ID: 7911932421 Enrollment ID: I20191023000025 |
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