Provider Demographics
NPI:1699079798
Name:LEDGERWOOD, ROSS (NP)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:LEDGERWOOD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 3RD ST UNIT 3372
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-4636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 W HIGHWAY 105 STE 100
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9119
Practice Address - Country:US
Practice Address - Phone:719-362-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992049363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201008350Medicaid
INP00921700OtherRAILROAD MEDICARE
IN000000711694OtherANTHEM BC/BS
IN000000711694OtherANTHEM BC/BS
INP00921700OtherRAILROAD MEDICARE