Dr Clark John Staheli, MD is a medicare enrolled "Family Medicine" physician in Dammeron Valley, Utah. His current practice location is
8555 North Highway 18, Dammeron Valley, Utah. You can reach out to his office (for appointments etc.) via phone at
(435) 574-2546.
Dr Clark John Staheli is licensed to practice in Utah (license number 148105-1205) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1568505691.
Physician's Profile
Full Name | Dr Clark John Staheli |
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Gender | Male |
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Speciality | Family Medicine |
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Location | 8555 North Highway 18, Dammeron Valley, Utah |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1568505691
- Provider Enumeration Date: 02/15/2007
- Last Update Date: 03/22/2011
Medicare PECOS Information:
- PECOS PAC ID: 7517918238
- Enrollment ID: I20060107000022
Medical Identifiers
Medical identifiers for Dr Clark John Staheli such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1568505691 | NPI | - | NPPES |
03698 | Medicaid | UT | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 1481051205 (Utah) | Secondary |
207Q00000X | Family Medicine | 148105-1205 (Utah) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Clark John Staheli is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Clark John Staheli, MD 8555 North Highway 18, Dammeron Valley, UT 84783 Ph: (801) 429-8000 | Dr Clark John Staheli, MD 8555 North Highway 18, Dammeron Valley, UT 84783 Ph: (435) 574-2546 |
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