| Pediatric Associates Prof Llc | |
|
947 So 5th St Montrose CO 81401-5716 | |
| (970) 249-2421 | |
| (970) 249-8897 |
| Full Name | Pediatric Associates Prof Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 947 So 5th St, Montrose, Colorado |
| Authorized Official Name and Position | Thomas Dawson Wiard (MANAGING/PARTNER) |
| Authorized Official Contact | 9702492421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Associates Prof Llc 947 So 5th St Montrose CO 81401-5716 Ph: (970) 249-2421 | Pediatric Associates Prof Llc 947 So 5th St Montrose CO 81401-5716 Ph: (970) 249-2421 |
| NPI Number | 1548261324 |
|---|---|
| Provider Enumeration Date | 08/03/2005 |
| Last Update Date | 01/13/2015 |
| Medicare PECOS PAC ID | 3375592637 |
|---|---|
| Medicare Enrollment ID | O20050113000921 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548261324 | NPI | - | NPPES |
| 25232339 | Medicaid | CO | |
| THF8408 | Other | CO | BLUE CROSS/BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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