Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 110 S 100 E, Circleville, Utah |
Authorized Official Name and Position | Deann Brown (ADMINISTRATOR) |
Authorized Official Contact | 4356768811 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 30180 Salt Lake City UT 84130-0180 Ph: () - | 110 S 100 E Circleville UT 84723 Ph: (435) 577-2958 |
NPI Number | 1649472796 |
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Provider Enumeration Date | 06/01/2007 |
Last Update Date | 06/23/2022 |
Medicare PECOS PAC ID | 6305744459 |
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Medicare Enrollment ID | O20050701000569 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649472796 | NPI | - | NPPES |
========= | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Melinda Lee Peterson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952008419 PECOS PAC ID: 1052766607 Enrollment ID: I20231017001988 |