| Affinity Healthcare, Inc. | |
|
2380 N 400 E Ste B North Logan UT 84341-1756 | |
| (435) 276-0888 | |
| (823) 471-4536 |
| Full Name | Affinity Healthcare, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2380 N 400 E Ste B, North Logan, Utah |
| Authorized Official Name and Position | Laval B Jensen (CEO) |
| Authorized Official Contact | 4352760888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affinity Healthcare, Inc. 2380 N 400 E Ste B North Logan UT 84341-1756 Ph: (435) 276-0888 | Affinity Healthcare, Inc. 2380 N 400 E Ste B North Logan UT 84341-1756 Ph: (435) 276-0888 |
| NPI Number | 1144928854 |
|---|---|
| Provider Enumeration Date | 02/21/2023 |
| Last Update Date | 11/15/2023 |
| Medicare PECOS PAC ID | 2062886815 |
|---|---|
| Medicare Enrollment ID | O20230320000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144928854 | NPI | - | NPPES |
| 3006721 | Medicaid | UT | |
| 4201995 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Glenn L. Robertson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144281122 PECOS PAC ID: 3870517618 Enrollment ID: I20060119000899 |
| Provider Name | Carla Knighton Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588297360 PECOS PAC ID: 6901236868 Enrollment ID: I20200417001337 |
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