MS. CAROL SUE CDEBACA PA-C NPI 1154518900

NPI Information

NPI: 1154518900
Provider Name: MS. CAROL SUE CDEBACA, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
101 KNOTBREAK RD
SALEM, VA
ZIP 24153
Phone: (540) 444-4020
Get Directions

MS. Carol Sue Cdebaca, PA-C is a surgical physician assistant in Salem, VA with 17 years of experience. MS. Carol Sue Cdebaca, PA-C NPI is 1154518900. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

101 KNOTBREAK RD
SALEM, VA
ZIP 24153-404
Phone: (540) 444-4020
Fax: (540) 857-5306

The NPI 1154518900 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/26/2007 and was last updated on 11/26/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	0110002628	VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	540506332115	OTHER	VIRGINIA	TRICARE
2	1154518900	OTHER	VIRGINIA	IN TOTAL
3	1154518900	OTHER	VIRGINIA	OPTIMA HEALTH PLAN
4	1154518900	OTHER	VIRGINIA	AETNA
5	1154518900	OTHER	VIRGINIA	HUMANA MEDICARE
6	1154518900	OTHER	VIRGINIA	ANTHEM MEDIGAP
7	P01464014	OTHER	VIRGINIA	RAILROAD MEDICARE
8	1154518900	OTHER	VIRGINIA	MEDICAID QMB
9	1154518900	OTHER	VIRGINIA	CCC VIRGINIA PREMIER
10	1154518900	OTHER	VIRGINIA	SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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