| Mountainlands Community Health Center, Inc | |
|
589 S State St Provo UT 84606-5056 | |
| (801) 429-2000 | |
| (801) 429-2001 |
| Full Name | Mountainlands Community Health Center, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 589 S State St, Provo, Utah |
| Authorized Official Name and Position | Karry Lontine (CREDENTIALING) |
| Authorized Official Contact | 8018550093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountainlands Community Health Center, Inc 589 South State Street Provo UT 84606-5056 Ph: (801) 429-2000 | Mountainlands Community Health Center, Inc 589 S State St Provo UT 84606-5056 Ph: (801) 429-2000 |
| NPI Number | 1427075134 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 08/10/2023 |
| Certification Date | 09/23/2022 |
| Medicare PECOS PAC ID | 6305872201 |
|---|---|
| Medicare Enrollment ID | O20050712000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427075134 | NPI | - | NPPES |
| 1012699 | Medicaid | UT |
| Provider Name | Salvador Fernandez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952491557 PECOS PAC ID: 3173508413 Enrollment ID: I20040622000189 |
| Provider Name | Bruce B Grover |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659391704 PECOS PAC ID: 7618054156 Enrollment ID: I20080408000215 |
| Provider Name | Vernon F White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396765376 PECOS PAC ID: 8628155199 Enrollment ID: I20080408000465 |
| Provider Name | Pahl G Bench |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588877674 PECOS PAC ID: 3476620469 Enrollment ID: I20080917000108 |
| Provider Name | Stacy Garnica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902151954 PECOS PAC ID: 1456579382 Enrollment ID: I20140905001282 |
| Provider Name | Karmin A Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699000570 PECOS PAC ID: 1759500580 Enrollment ID: I20140910000268 |
| Provider Name | Eric Evon Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710311279 PECOS PAC ID: 9537388038 Enrollment ID: I20140916000789 |
| Provider Name | Leslie Divall |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1639539521 PECOS PAC ID: 1355648056 Enrollment ID: I20160323002140 |
| Provider Name | Monroe Moody White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710907795 PECOS PAC ID: 9234464801 Enrollment ID: I20190718002122 |
| Provider Name | Maria De Jesus Villagrana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295347169 PECOS PAC ID: 1355761719 Enrollment ID: I20201023001457 |
| Provider Name | Matias A Calquin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093343980 PECOS PAC ID: 3971993841 Enrollment ID: I20211208001518 |
| Provider Name | Cameron Gregory Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760019699 PECOS PAC ID: 4981082898 Enrollment ID: I20220606002118 |
| Provider Name | Raquel Vazquez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1518690890 PECOS PAC ID: 2062871742 Enrollment ID: I20230629000974 |
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