| Ad Clinical | |
|
8465 S 700 E Sandy UT 84070-0501 | |
| (801) 233-8577 | |
| (801) 233-8748 |
| Full Name | Ad Clinical |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8465 S 700 E, Sandy, Utah |
| Authorized Official Name and Position | Michael E Dusoe (OWNER DIRECTOR) |
| Authorized Official Contact | 8012338577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ad Clinical 8465 S 700 E Sandy UT 84070-0501 Ph: (801) 233-8577 | Ad Clinical 8465 S 700 E Sandy UT 84070-0501 Ph: (801) 233-8577 |
| NPI Number | 1689899171 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 06/16/2008 |
| Medicare PECOS PAC ID | 2567492309 |
|---|---|
| Medicare Enrollment ID | O20050822000224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689899171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 12555 (Utah) | Primary |
| Provider Name | Valerie Jean Flattes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972650836 PECOS PAC ID: 4284677303 Enrollment ID: I20050608001147 |
| Provider Name | Michael O Measom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861479701 PECOS PAC ID: 4385661388 Enrollment ID: I20051028000675 |
| Provider Name | Michael E Dusoe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477664670 PECOS PAC ID: 8820028665 Enrollment ID: I20110715000160 |
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