Healthcare Provider Details

I. General information

NPI: 1982175311
Provider Name (Legal Business Name): BLOOM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

IV. Provider business mailing address

10900 W 44TH AVE UNIT 200
WHEAT RIDGE CO
80033-2742
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax:
Mailing address:
  • Phone: 303-993-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA K WADELTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 303-993-1330