Provider Demographics
NPI:1588748909
Name:DEBORAH L CHADWICK, MD, PC
Entity type:Organization
Organization Name:DEBORAH L CHADWICK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-874-8026
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1129
Mailing Address - Country:US
Mailing Address - Phone:970-874-2470
Mailing Address - Fax:970-874-7482
Practice Address - Street 1:95 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3465
Practice Address - Country:US
Practice Address - Phone:970-874-8026
Practice Address - Fax:970-874-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41117208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCH663005OtherBCBS
CO32051026Medicaid
CO32051026Medicaid
COC490078Medicare PIN
CO=========001OtherROCKY MOUNTAIN HEALTH PLA
CO32051026Medicaid