MS. CAROL SUE CDEBACA (NPI# 1154518900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154518900 |
| Entity Type | Individual |
| Full Name | MS. CAROL SUE CDEBACA |
| Credential | PA-C |
| Practice Address |
101 Knotbreak Rd Salem VA 24153-5404 |
| Mailing Address |
2331 Franklin Rd Sw Roanoke VA 24014-1111 |
| Practice Telephone | 5404444020 |
| Practice Fax Number | 5408575306 |
| Mailing Telephone | 5407251226 |
| Mailing Fax Number | 5408575306 |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2019-11-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
0110002628 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | TRICARE | 540506332115 | 01 |
| VA | IN TOTAL | 1154518900 | 01 |
| VA | OPTIMA HEALTH PLAN | 1154518900 | 01 |
| VA | AETNA | 1154518900 | 01 |
| VA | HUMANA MEDICARE | 1154518900 | 01 |
| VA | ANTHEM MEDIGAP | 1154518900 | 01 |
| VA | RAILROAD MEDICARE | P01464014 | 01 |
| VA | MEDICAID QMB | 1154518900 | 01 |
| VA | CCC VIRGINIA PREMIER | 1154518900 | 01 |
| VA | SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY | 1154518900 | 01 |
| Street Address |
101 KNOTBREAK RD |
| City | SALEM |
| State | VA |
| Zip Code | 24153-5404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013988161 | James Mastin Farmer | Orthopaedic Surgery | 101 Knotbreak Rd, Salem, VA 24153-5404 | 2006-01-27 |
| 1801343231 | Christopher Deneault | Physician Assistant | 101 Knotbreak Rd, Salem, VA 24153-5404 | 2016-09-01 |
| 1326334293 | Jeremy Curtis Smalley | Orthopaedic Surgery | 101 Knotbreak Rd, Salem, VA 24153-5404 | 2011-06-20 |
| 1700828878 | Gregory David Riebel | Orthopaedic Surgery | 101 Knotbreak Rd, Salem, VA 24153-5404 | 2006-06-12 |
| 1457322398 | Christopher Guth | Physician Assistant | 101 Knotbreak Rd, Salem, VA 24153-5404 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669001228 | Paul Mcguire | Student in an Organized Health Care Education/Training Program | 1906 Braeburn Drive Psychiatry Gme, Salem, VA 24153 | 2020-04-06 |
| 1386114965 | Dynamic Medical LLC | Clinical Medical Laboratory | 1201 Texas Street, Salem, VA 24153 | 2018-11-27 |
| 1134607898 | Renew Psychiatry Services | Psychiatry & Neurology | 177 Electric Rd, Salem, VA 24153 | 2018-08-03 |
| 1508304015 | Samantha Getz | Assisted Living Facility | 3706 Knollridge Rd., Salem, VA 24153 | 2017-02-03 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1154729051 | Allison Marie Parry | Physician Assistant | 1336 W Main St., Salem, VA 24153 | 2014-12-09 |
| 1598199457 | Stacy Stanley | Occupational Therapy Assistant | 4812 Moore Rd, Salem, VA 24153 | 2013-08-28 |
| 1366888034 | Dolores Hager | Speech-Language Pathologist | 1851 Harrogate Dr, Salem, VA 24153 | 2013-05-21 |
| 1073850764 | Joel Aaron Nickerson | Specialist/Technologist | 400 Spartan Dr., Salem High School, Salem, VA 24153 | 2013-01-15 |
| 1023387271 | National Diabetic Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 2153 Apperson Drive, Salem, VA 24153 | 2011-12-16 |
| Find all providers in zip 24153 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245538990 | Megan S Welch | Physician Assistant | 16 Pelham Rd Ste 1, Salem, NH 03079 | 2011-03-04 |
| 1265971386 | Angela Rehder | Physician Assistant | 875 Oak St Se, Suite 5020, Salem, OR 97301 | 2017-02-22 |
| 1942757224 | Rebecca Theisen | Physician Assistant | 1600 State St, Salem, OR 97301-4257 | 2016-09-05 |
| 1184965253 | Casey Lewis Shaw | Physician Assistant | 1600 State St, Salem, OR 97301-4257 | 2013-03-13 |
| 1093062960 | Christopher J Shields | Physician Assistant | 16 Pelham Rd, Ste 1, Salem, NH 03079-2826 | 2012-08-10 |
| 1851658975 | Nicole L Kehrer | Physician Assistant | 1600 State St, Salem, OR 97301-4257 | 2012-04-13 |
| 1063795003 | Kevin Michael Dennis | Physician Assistant | 875 Oak St Se, Suite 5020, Salem, OR 97301-3975 | 2011-09-26 |
| 1386948347 | Timothy Tseng | Physician Assistant | 1233 Edgewater St Nw, Salem, OR 97304-4049 | 2011-01-05 |
| 1144520453 | Melissa Brooke Barone | Physician Assistant | 875 Oak St Se, Suite 5020, Salem, OR 97301-3975 | 2010-11-02 |
| 1700110616 | Dana Nicole Schenker | Physician Assistant | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2009-09-24 |
| Find all providers in SALEM | ||||
Please comment or provide details below to improve the information on MS. CAROL SUE CDEBACA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.