| Sentry Medical | |
|
258 S Main St Ste 210 Logan UT 84321-5768 | |
| (435) 383-6120 | |
| (435) 557-8003 |
| Full Name | Sentry Medical |
|---|---|
| Speciality | Internal Medicine |
| Location | 258 S Main St Ste 210, Logan, Utah |
| Authorized Official Name and Position | Tyler Pace (PRESIDENT) |
| Authorized Official Contact | 4353836120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sentry Medical 258 S Main St Ste 210 Logan UT 84321-5768 Ph: (435) 383-6120 | Sentry Medical 258 S Main St Ste 210 Logan UT 84321-5768 Ph: (435) 383-6120 |
| NPI Number | 1568928133 |
|---|---|
| Provider Enumeration Date | 02/19/2019 |
| Last Update Date | 04/19/2023 |
| Medicare PECOS PAC ID | 4981937034 |
|---|---|
| Medicare Enrollment ID | O20190605001965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568928133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Todd K Larson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568159630 PECOS PAC ID: 9436178258 Enrollment ID: I20051121001052 |
| Provider Name | Ryan H Larsen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1235224932 PECOS PAC ID: 3971525064 Enrollment ID: I20060104000144 |
| Provider Name | Brett Cardon Porter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134175037 PECOS PAC ID: 8628975463 Enrollment ID: I20060110000303 |
| Provider Name | Roger L Colvin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1740390988 PECOS PAC ID: 5991752743 Enrollment ID: I20080328000310 |
| Provider Name | David Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386676526 PECOS PAC ID: 7416098967 Enrollment ID: I20100106000686 |
| Provider Name | Burke D Maughan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306861315 PECOS PAC ID: 2062447923 Enrollment ID: I20160311000016 |
| Provider Name | Jacob Brian Sanderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265094742 PECOS PAC ID: 3971834441 Enrollment ID: I20191015000287 |
| Provider Name | Carla Knighton Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588297360 PECOS PAC ID: 6901236868 Enrollment ID: I20200417001337 |
| Provider Name | Karen Bowcutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447850755 PECOS PAC ID: 4688082225 Enrollment ID: I20210420000429 |
| Provider Name | Clark George Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407124910 PECOS PAC ID: 9537545157 Enrollment ID: I20221005003383 |
| Provider Name | Miranda Paulsen Buttars |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144913344 PECOS PAC ID: 1153781695 Enrollment ID: I20230717000668 |
| Provider Name | Abish Sanderson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1447629035 PECOS PAC ID: 1456712181 Enrollment ID: I20230727003817 |
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