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Organization
BLOOM PRIMARY MO, LLC
Active
Organization
BLOOM PRIMARY MO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA KAY MOON-WADELTON MOON-WADELTON (REVENUE CYCLE MANAGER)
(720) 923-1250
Entity
Organization
Contact information
Practice address
540 MARYVILLE CENTRE DR STE 340, SAINT LOUIS, MO 63141-5831
(720) 923-1250
Mailing address
12600 W COLFAX AVE STE B200, LAKEWOOD, CO 80215-3736
(720) 923-1250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/13/2026
Last updated
02/13/2026
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