MEDICARE: BLOOM PHYSICIAN HOUSECALLS PA

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

General Provider Information

NPI Number	:	1770322299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM PHYSICIAN HOUSECALLS PA

Provider Business Mailing Address
First Line	:	PO BOX 17112
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-0112
Country	:	US
Telephone Number	:	720-923-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 W IH 10 STE 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3879
Country	:	US
Telephone Number	:	303-993-1330
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DEBRA MOON WADELTON
Credential	:
Telephone Number	:	720-923-1250

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/05/2026

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Directions to “BLOOM PHYSICIAN HOUSECALLS PA ” Practice Location

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