MEDICARE: DR. DENNIS J. JELDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34972	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080121472	OTHER	CO	RR MEDICARE PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	846014138007	OTHER	CO	ROCKY MTN HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	84601413802	OTHER	CO	PACIFICARE PROV #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	FA231008	OTHER	CO	BCBS PROV #
7	00017329	OTHER	CO	BANNERHEALTH PROV #

General Provider Information

NPI Number	:	1427065549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS J. JELDEN MD

Provider Business Mailing Address
First Line	:	1001 E. JOHNSON STREET
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2500
Fax Number	:	970-854-3440

Provider Business Practice Location Address
First Line	:	1001 E. JOHNSTON STREET
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2500
Fax Number	:	970-854-3440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	05/13/2010

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Directions to “ DR. DENNIS J. JELDEN MD” Practice Location

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