Carl Thayne Wilson, MD | |
1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 | |
(801) 507-5248 | |
(801) 733-5618 |
Full Name | Carl Thayne Wilson |
---|---|
Gender | Male |
Speciality | Anesthesiology |
Location | 1034 North 500 West, Provo, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073608659 | NPI | - | NPPES |
2090168 | Other | UT | UNITED HEALTHCARE |
768046 | Medicaid | AZ | |
37038 | Other | UT | DESERET MUTUAL |
806095300 | Medicaid | ID | |
8597445 | Other | UT | WORKERS COMP |
1502954 | Other | UT | UMWA |
37831 | Other | UT | PEHP |
870545614WI1 | Other | UT | EDUCATORS MUTUAL |
TPRA07712 | Other | UT | MOLINA |
QM0000075886 | Other | UT | ALTIUS |
107005544101 | Other | UT | IHC |
119214100 | Medicaid | WY | |
53282 | Other | UT | HEALTHY U |
002089788 | Medicaid | NV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207L00000X | Anesthesiology | 88-179937-1205 (Utah) | Primary |
Entity Name | Mountain West Anesthesia Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1558391763 PECOS PAC ID: 9032018502 Enrollment ID: O20040103000057 |
Entity Name | Family Surgical Suite |
---|---|
Entity Type | Part B Supplier - Ambulatory Surgical Center |
Entity Identifiers | NPI Number: 1508040221 PECOS PAC ID: 6901989003 Enrollment ID: O20080213000228 |
Mailing Address | Practice Location Address |
---|---|
Carl Thayne Wilson, MD 3340 North Center St, #800, Lehi, UT 84043-7406 Ph: (801) 990-1911 | Carl Thayne Wilson, MD 1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 Ph: (801) 507-5248 |
Dr. Daniel Rey Faber, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 280 River Park Dr, #200, Provo, UT 84604 Phone: 801-223-4860 Fax: 801-371-8993 | |
John B Zimmerman, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 Phone: 801-507-5248 Fax: 801-733-5618 | |
David Groesbeck, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 Phone: 801-507-5248 Fax: 801-733-5618 | |
Mr. Matthew David Wagaman, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1034 N 500 W, Provo, UT 84604 Phone: 801-357-7850 Fax: 770-701-6675 | |
Mitchell D Albrecht, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1034 N 500 W, Provo, UT 84004 Phone: 801-993-9582 Fax: 801-733-5618 | |
Mark Critchfield, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 Phone: 801-507-5248 Fax: 801-733-5618 |