| Progeny Psychiatric Group Utah | |
|
6621 W Wide Hollow Dr Herriman UT 84096-3550 | |
| (949) 688-3903 | |
| Not Available |
| Full Name | Progeny Psychiatric Group Utah |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6621 W Wide Hollow Dr, Herriman, Utah |
| Authorized Official Name and Position | Chelcie Adam (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9496883903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Progeny Psychiatric Group Utah 6621 W Wide Hollow Dr Herriman UT 84096-3550 Ph: () - | Progeny Psychiatric Group Utah 6621 W Wide Hollow Dr Herriman UT 84096-3550 Ph: (949) 688-3903 |
| NPI Number | 1538753025 |
|---|---|
| Provider Enumeration Date | 02/24/2021 |
| Last Update Date | 05/11/2021 |
| Certification Date | 05/11/2021 |
| Medicare PECOS PAC ID | 2567868417 |
|---|---|
| Medicare Enrollment ID | O20210901002184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538753025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Randall G Turner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164696993 PECOS PAC ID: 8628233566 Enrollment ID: I20210901002266 |
| Provider Name | Jesse Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609248202 PECOS PAC ID: 9133557697 Enrollment ID: I20210907001307 |
| Provider Name | Clint H Salo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811159221 PECOS PAC ID: 5193988301 Enrollment ID: I20210907001700 |
| Provider Name | Sean Patrick Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518458165 PECOS PAC ID: 7214291731 Enrollment ID: I20211123001408 |
| Provider Name | Abishek R Rizal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518132067 PECOS PAC ID: 8426207937 Enrollment ID: I20221027002521 |
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