Organization
BLOOM HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA K WADELTON (REVENUE CYCLE MANAGER)
(970) 946-4607
Entity
Organization
Contact information
Practice address
954 SEDGEFIELD CT, MAINEVILLE, OH 45039-7513
(970) 946-4607
Mailing address
10900 W 44TH AVE UNIT 200, WHEAT RIDGE, CO 80033-2742
(970) 946-4607
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16108272
—
CO
Enumeration date
12/11/2018
Last updated
12/11/2018
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