| Doctor Name: | MS. PEGGY MIRL WADE |
| NPI Number: | 1871829655 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 00484 |
| Business Practice Address: | 32850 Saint Andrews Dr Thousand Palms, CA - 922762711 |
| Business Phone Number: | 7604690256 |
| Business Fax Number: | 7603432300 |
| Mailing Address: | Po Box 644, THOUSAND PALMS |
| State: | CA |
| Postal Code: | 922760644 |
| Phone Number: | 7603432300 |
| Fax Number: | 7603432300 |
| NPI Enumeration Date: | 10/28/2009 |
| NPI Last Update Date: | 10/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305S00000X |
| License Number: | 00484 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Point of Service |
| Taxonomy Specialization: | |
| Taxonomy Definition: | This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |