| Confederated Tribes Of The Goshute Reservation | |
|
195 Tribal Center Rd Ibapah UT 84034 | |
| (435) 234-1194 | |
| (435) 234-1202 |
| Full Name | Confederated Tribes Of The Goshute Reservation |
|---|---|
| Speciality | General Practice |
| Location | 195 Tribal Center Rd, Ibapah, Utah |
| Authorized Official Name and Position | Crystal Contreras (BILLING) |
| Authorized Official Contact | 8013592256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Confederated Tribes Of The Goshute Reservation 660 S 200 E Ste 250 Salt Lake City UT 84111-3846 Ph: (801) 359-2256 | Confederated Tribes Of The Goshute Reservation 195 Tribal Center Rd Ibapah UT 84034 Ph: (435) 234-1194 |
| NPI Number | 1750510277 |
|---|---|
| Provider Enumeration Date | 07/06/2009 |
| Last Update Date | 02/05/2020 |
| Medicare PECOS PAC ID | 0042451650 |
|---|---|
| Medicare Enrollment ID | O20130724000653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750510277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Kristi L Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811349780 PECOS PAC ID: 0840577250 Enrollment ID: I20170511001248 |
| Provider Name | Leon Harvey Butler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245549773 PECOS PAC ID: 3173701836 Enrollment ID: I20170512000965 |
| Provider Name | Lindsay J Roper |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245424985 PECOS PAC ID: 5496844201 Enrollment ID: I20171013002691 |
| Provider Name | Clark C Larsen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1427130335 PECOS PAC ID: 4789786104 Enrollment ID: I20180122001937 |
| Provider Name | Thomas Eddy |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1528354693 PECOS PAC ID: 0244519932 Enrollment ID: I20180213002069 |
| Provider Name | Samuel J Otto |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1154565273 PECOS PAC ID: 9234103177 Enrollment ID: I20180518001463 |
| Provider Name | Melissa J Bentley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639354897 PECOS PAC ID: 2961556261 Enrollment ID: I20181011000143 |
| Provider Name | Elizabeth Annas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598238594 PECOS PAC ID: 8921346917 Enrollment ID: I20190218001439 |
| Provider Name | Megan H Kimberly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932645256 PECOS PAC ID: 4082989280 Enrollment ID: I20190227000310 |
| Provider Name | Matthew Lewis |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1457722563 PECOS PAC ID: 7113253733 Enrollment ID: I20190719001145 |
| Provider Name | Elizabeth Neilson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003474602 PECOS PAC ID: 2466780804 Enrollment ID: I20190823000922 |
| Provider Name | Daniel D Hansen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1316325590 PECOS PAC ID: 1759639446 Enrollment ID: I20190829001053 |
| Provider Name | Hans C Jenkins |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1316932866 PECOS PAC ID: 4688738859 Enrollment ID: I20191120000110 |
| Provider Name | Miguel A Villalobos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073572228 PECOS PAC ID: 0143111062 Enrollment ID: I20200626000519 |
| Provider Name | Annalisa Blackham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932416963 PECOS PAC ID: 7214354646 Enrollment ID: I20200901000206 |
| Provider Name | Brad R Christensen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124370440 PECOS PAC ID: 0547687881 Enrollment ID: I20200901000701 |
| Provider Name | Crystal A Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104468503 PECOS PAC ID: 2365860285 Enrollment ID: I20200909002172 |
| Provider Name | Timothy M Golder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780162628 PECOS PAC ID: 7618227752 Enrollment ID: I20201001000899 |
| Provider Name | John L Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932488426 PECOS PAC ID: 0143493049 Enrollment ID: I20201012000158 |
| Provider Name | Scott M Smid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780799973 PECOS PAC ID: 7214989607 Enrollment ID: I20201015000712 |
| Provider Name | Megan S Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669071395 PECOS PAC ID: 0244640845 Enrollment ID: I20201111000391 |
| Provider Name | Cuper Martinez Santibanez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891238481 PECOS PAC ID: 0749557130 Enrollment ID: I20210105000843 |
| Provider Name | Arlene R Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245890383 PECOS PAC ID: 8729402375 Enrollment ID: I20210114001460 |
| Provider Name | Donald R Baker |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457438061 PECOS PAC ID: 2961560396 Enrollment ID: I20210203002647 |
| Provider Name | Carissa S Monroy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760610349 PECOS PAC ID: 9830236819 Enrollment ID: I20211011001483 |
| Provider Name | Elsha D Drummond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982372116 PECOS PAC ID: 4981096815 Enrollment ID: I20220126001137 |
| Provider Name | Saskia Spiess |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689966004 PECOS PAC ID: 1153541339 Enrollment ID: I20220127002100 |
| Provider Name | Katherine R May |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760792584 PECOS PAC ID: 0244539997 Enrollment ID: I20220207000370 |
| Provider Name | Keith J. Castleton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730168071 PECOS PAC ID: 0840345260 Enrollment ID: I20220221001031 |
| Provider Name | John Benjamin Dame |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922205947 PECOS PAC ID: 1456445618 Enrollment ID: I20220228001669 |
| Provider Name | Darrin W Tuckett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447696133 PECOS PAC ID: 6103049697 Enrollment ID: I20220328002238 |
| Provider Name | Secadio J Sanchez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922631381 PECOS PAC ID: 9638556251 Enrollment ID: I20220519001133 |
| Provider Name | Cassandra A Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750031753 PECOS PAC ID: 5698155422 Enrollment ID: I20220711000715 |
| Provider Name | David M Swan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861049363 PECOS PAC ID: 4183045040 Enrollment ID: I20220820000101 |
| Provider Name | Darrel J Thompson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922649359 PECOS PAC ID: 3375928955 Enrollment ID: I20220919000049 |
| Provider Name | Sungah Shin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669939401 PECOS PAC ID: 8921484254 Enrollment ID: I20221010002301 |
| Provider Name | Kelly Hollie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386253532 PECOS PAC ID: 6608244686 Enrollment ID: I20221122003507 |
| Provider Name | Ryan Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356755581 PECOS PAC ID: 6608245501 Enrollment ID: I20221215003183 |
| Provider Name | Gina M Makouske |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487220224 PECOS PAC ID: 8729458542 Enrollment ID: I20230111002507 |
| Provider Name | Sarah Ranger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366748998 PECOS PAC ID: 6002286861 Enrollment ID: I20230112001145 |
| Provider Name | Jillian Danielle Shiembob |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679868939 PECOS PAC ID: 1153591300 Enrollment ID: I20230202002388 |
| Provider Name | Alyssa B Snyder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093431546 PECOS PAC ID: 6406229707 Enrollment ID: I20230308000432 |
| Provider Name | Yanabah T Wood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497328090 PECOS PAC ID: 0244605947 Enrollment ID: I20230411002847 |
| Provider Name | Tayler W Pace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588209399 PECOS PAC ID: 2567822901 Enrollment ID: I20230718000985 |
| Provider Name | Jacqueline F Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720765894 PECOS PAC ID: 1153783311 Enrollment ID: I20230821000563 |
| Provider Name | Joanne V Chan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902476237 PECOS PAC ID: 5193173383 Enrollment ID: I20231129000284 |
| Provider Name | Deojuvanteh Tso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912547191 PECOS PAC ID: 3870941073 Enrollment ID: I20231129000833 |
| Provider Name | Matthew B Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710525266 PECOS PAC ID: 7517347123 Enrollment ID: I20231206003764 |
| Provider Name | David D Mortensen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1871590430 PECOS PAC ID: 0648175299 Enrollment ID: I20231206003888 |
| Provider Name | Haven A L Halk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972007060 PECOS PAC ID: 9032473590 Enrollment ID: I20231212000053 |
| Provider Name | Stacey Bank |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790797959 PECOS PAC ID: 7517983232 Enrollment ID: I20240124003464 |
| Provider Name | Richard F Labasky |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1538226600 PECOS PAC ID: 8820909567 Enrollment ID: I20240130000777 |
| Provider Name | Anna C Eastman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386138758 PECOS PAC ID: 2466897905 Enrollment ID: I20240223003393 |
| Provider Name | Melissa M Vernon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962071761 PECOS PAC ID: 1557706694 Enrollment ID: I20240229000075 |
| Provider Name | Danielle R Puri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003287434 PECOS PAC ID: 0244531564 Enrollment ID: I20240229000183 |
| Provider Name | Latai Tuivai |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427624287 PECOS PAC ID: 6204280753 Enrollment ID: I20240313000874 |
Confederated Tribes Of The Goshute Reservation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Hc 61 Box 6104, Ibapah, UT 84034 Phone: 435-234-1138 |