Provider Demographics
NPI:1720154669
Name:ADAMS, MICHAEL C (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NORTH AVE.
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-424-0731
Mailing Address - Fax:970-327-4228
Practice Address - Street 1:2121 NORTH AVE.
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-242-0731
Practice Address - Fax:970-327-4228
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1079363A00000X
COPA0001079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82504024Medicaid
COCO300294OtherMEDICARE B WITH BASIN CLINIC
CO825040024Medicaid
CO82504024Medicaid