Basic Information
| Provider Information | |||||||||
| NPI: | 1720154669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 NORTH AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704240731 | ||||||||
| FaxNumber: | 9703274228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 NORTH AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702420731 | ||||||||
| FaxNumber: | 9703274228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1079 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA0001079 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 82504024 | 05 | CO | MEDICAID | CO300294 | 01 | CO | MEDICARE B WITH BASIN CLINIC | OTHER | 825040024 | 05 | CO | MEDICAID |