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3051 W Maple Loop Dr Ste 125 Lehi UT 84043-5620 | |
| (801) 766-6055 | |
| (888) 611-8840 |
| Full Name | |
|---|---|
| Speciality | Pain Medicine |
| Location | 3051 W Maple Loop Dr Ste 125, Lehi, Utah |
| Authorized Official Name and Position | Brent H Egan (PRESIDENT) |
| Authorized Official Contact | 8017666055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3051 W Maple Loop Dr Ste 125 Lehi UT 84043-5620 Ph: (801) 766-6055 | 3051 W Maple Loop Dr Ste 125 Lehi UT 84043-5620 Ph: (801) 766-6055 |
| NPI Number | 1255844015 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/16/2024 |
| Medicare PECOS PAC ID | 8123388030 |
|---|---|
| Medicare Enrollment ID | O20180213002702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255844015 | NPI | - | NPPES |
| 1063492304 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Primary |
| Provider Name | Brent Egan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376634998 PECOS PAC ID: 3173566916 Enrollment ID: I20150717000386 |
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