Healthcare Provider Details

I. General information

NPI: 1982679650
Provider Name (Legal Business Name): JEFFREY SCOTT HEDLUND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 EAGLE DR
LOVELAND CO
80537-8020
US

IV. Provider business mailing address

1159 EAGLE DR
LOVELAND CO
80537-8020
US

V. Phone/Fax

Practice location:
  • Phone: 970-219-5223
  • Fax: 970-449-1606
Mailing address:
  • Phone: 970-219-5223
  • Fax: 970-449-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009853
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0453
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11947
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: