| Family Tree Preventative Medicine Llc | |
|
5185 S 2275 W Roy UT 84067-3442 | |
| (801) 698-2144 | |
| Not Available |
| Full Name | Family Tree Preventative Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5185 S 2275 W, Roy, Utah |
| Authorized Official Name and Position | Debra J Vigil (OWNER) |
| Authorized Official Contact | 8016982144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Tree Preventative Medicine Llc 5185 S 2275 W Roy UT 84067-3442 Ph: (801) 698-2144 | Family Tree Preventative Medicine Llc 5185 S 2275 W Roy UT 84067-3442 Ph: (801) 698-2144 |
| NPI Number | 1043903024 |
|---|---|
| Provider Enumeration Date | 05/26/2023 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 2961856042 |
|---|---|
| Medicare Enrollment ID | O20230922001671 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043903024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Debra Vigil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821419490 PECOS PAC ID: 5193049070 Enrollment ID: I20170215002581 |
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