Organization
PEDIATRIC ASSOCIATES PROF LLC
Active
Other names
The Pediatric Associates
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS DAWSON WIARD MD (MANAGING/PARTNER)
(970) 249-2421
Entity
Organization
Contact information
Practice address
947 SO 5TH ST, MONTROSE, CO 81401-5716
(970) 249-2421
(970) 249-8897
Mailing address
947 SO 5TH ST, MONTROSE, CO 81401-5716
(970) 249-2421
(970) 249-8897
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25232339
—
CO
01
—
THF8408
BLUE CROSS/BLUE SHIELD
CO
Enumeration date
08/03/2005
Last updated
01/13/2015
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