Basic Information
| Provider Information | |||||||||
| NPI: | 1932122702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDMONDS | ||||||||
| FirstName: | HOPE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6746A | WY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0042158 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 82009A049 | 01 | WY | WPS TRIWEST | OTHER | 117362600 | 05 | WY | MEDICAID | 311508 | 01 | WY | BLUE SHIELD | OTHER | 930116063 | 01 | WY | RAILROAD MEDICARE | OTHER | 13662 | 01 | WY | WINHEALTH PARTNERS | OTHER |