Edenmd Wellness LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EDENMD WELLNESS LLC

Practice address

7760 E State Route 69 Ste C5-342
Prescott Valley, AZ 86314-2201

Phone

(602) 525-8530

NPI assigned

Oct 26, 2022

Last updated

Nov 7, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ruth Forde, MDNPI 1598932345

Title

Physician, Partner, Administrator

Phone

(956) 607-4880

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ruth S Forde, M.D.

  • Family Medicine Physician
  • Represa, CA
  • NPI 1598932345
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1801513114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 E DESPERADO DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863145824",
            "telephone_number": "956-607-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7760 E STATE ROUTE 69 STE C5-342",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142201",
            "telephone_number": "602-525-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENMD WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-26",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "FORDE",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "PHYSICIAN, PARTNER, ADMINISTRATOR",
        "authorized_official_telephone_number": "956-607-4880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Dunagan, LMT
• Elizabeth B Dunn, M.S.
• Patricia L Dzenis
• E Z Sleep Lab (E Z Sleep Lab- Prescott Valley)
• Chelsey Earnhart, DNP, CPNP-PC
• Eleanor Eunice Tubat Edmilao
• Edward M. Reifman, DDS Inc
• Robert Lee Edwards III, LDO
• Stacey Margarette Edwards, SLPA
• Denise M Eldred, PT

• Family Medicine Physician in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.