| Country Healthcare Llc | |
|
35 N 500 W Lehi UT 84043-1755 | |
| (385) 383-3103 | |
| (385) 352-1003 |
| Full Name | Country Healthcare Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 35 N 500 W, Lehi, Utah |
| Authorized Official Name and Position | Virginia Jefferies (OWNER) |
| Authorized Official Contact | 3853525545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Country Healthcare Llc 35 N 500 W Lehi UT 84043-1755 Ph: (385) 352-5545 | Country Healthcare Llc 35 N 500 W Lehi UT 84043-1755 Ph: (385) 383-3103 |
| NPI Number | 1578224671 |
|---|---|
| Provider Enumeration Date | 01/01/2022 |
| Last Update Date | 03/01/2023 |
| Medicare PECOS PAC ID | 7113304338 |
|---|---|
| Medicare Enrollment ID | O20220509002291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578224671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Virginia J Roy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598312753 PECOS PAC ID: 5890026785 Enrollment ID: I20191007003367 |
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