| Brand Paxton Reynolds | |
|
491 North Main Street Tooele UT 84074-0922 | |
| (435) 843-8881 | |
| (435) 843-8802 |
| Full Name | Brand Paxton Reynolds |
|---|---|
| Speciality | Clinic/Center |
| Location | 491 North Main Street, Tooele, Utah |
| Authorized Official Name and Position | Brand Paxton Reynolds (OWNER) |
| Authorized Official Contact | 4358438881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brand Paxton Reynolds 491 N Main St Tooele UT 84074-1654 Ph: (435) 843-8881 | Brand Paxton Reynolds 491 North Main Street Tooele UT 84074-0922 Ph: (435) 843-8881 |
| NPI Number | 1548302268 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 12/17/2020 |
| Medicare PECOS PAC ID | 5991769614 |
|---|---|
| Medicare Enrollment ID | O20041112000815 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548302268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 271062-4405 (Utah) | Primary |
| Provider Name | Brand P Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154325991 PECOS PAC ID: 1254395973 Enrollment ID: I20041118000249 |
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