1669429049 NPI number — WADE M CEOLA M.D.

Table of content: WADE M CEOLA M.D. (NPI 1669429049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669429049 NPI number — WADE M CEOLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CEOLA
Provider First Name:
WADE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669429049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1906 BLAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81601-4227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-384-6770
Provider Business Mailing Address Fax Number:
970-384-6610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 BLAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD SPGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-4227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-384-6770
Provider Business Practice Location Address Fax Number:
970-384-6610
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  2001013105 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: E1615 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 53071 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2950416001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 51383527 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5M325 . This is a "HEALTH ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 02080001300 . This is a "QUAL CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 143659 . This is a "BLUE CROSS/CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 148899001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5M325 . This is a "ARKANSAS BC/BS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0214842 . This is a "DEPARTMENT OF LABOR WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 13751 . This is a "COX HEALTH PLANS UPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 468970 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0600090 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4188130001 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: H36801 . This is a "USPS (W/C)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5M325 . This is a "ARKANSAS FIRST SOURCE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 18942 . This is a "COX HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 205393804 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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