Provider Demographics
NPI:1396077319
Name:MM WADDELL HEALTH SERVICES INC
Entity type:Organization
Organization Name:MM WADDELL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MELROSE
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-384-7526
Mailing Address - Street 1:3205 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3028
Mailing Address - Country:US
Mailing Address - Phone:720-384-7526
Mailing Address - Fax:303-839-7936
Practice Address - Street 1:3205 S HIGH ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3028
Practice Address - Country:US
Practice Address - Phone:720-384-7526
Practice Address - Fax:303-839-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42011282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32278845Medicaid
COC806878OtherMEDICARE PTAN
G88354OtherUPIN