| Elk Ridge Family Practice Pc | |
|
1172 E 100 N Ste 11 Payson UT 84651-1668 | |
| (801) 465-6100 | |
| (801) 465-6114 |
| Full Name | Elk Ridge Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1172 E 100 N Ste 11, Payson, Utah |
| Authorized Official Name and Position | Dennis Michael Concoby (PRESIDENT) |
| Authorized Official Contact | 8014656100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elk Ridge Family Practice Pc 1172 E 100 N Ste 11 Payson UT 84651-1668 Ph: (801) 465-6100 | Elk Ridge Family Practice Pc 1172 E 100 N Ste 11 Payson UT 84651-1668 Ph: (801) 465-6100 |
| NPI Number | 1356519656 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 11/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356519656 | NPI | - | NPPES |
| 530117654001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5656211-1204 (Utah) | Primary |
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