Fourth Street Clinic in Salt Lake City, UT

Fourth Street Clinic is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Salt Lake City, Utah. The current practice location for Fourth Street Clinic is 409 W 400 S, Salt Lake City, Utah. For appointments, you can reach them via phone at (801) 364-0058. The mailing address for Fourth Street Clinic is 409 W 400 S, Salt Lake City, Utah and phone number is (801) 364-0058.

Fourth Street Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1528128899. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (801) 364-0058.

Contact Information

	Fourth Street Clinic
	409 W 400 S Salt Lake City UT 84101-1135
	(801) 364-0058
	(801) 364-0161

Map and Direction

Primary Care Clinic Profile

Full Name	Fourth Street Clinic
Speciality	Clinic/Center
Location	409 W 400 S, Salt Lake City, Utah
Authorized Official Name and Position	Janida Emerson (CEO)
Authorized Official Contact	8013640058
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Fourth Street Clinic 409 W 400 S Salt Lake City UT 84101-1135 Ph: (801) 364-0058	Fourth Street Clinic 409 W 400 S Salt Lake City UT 84101-1135 Ph: (801) 364-0058

NPI Details:

NPI Number	1528128899
Provider Enumeration Date	12/09/2006
Last Update Date	11/24/2020

Medicare PECOS Information:

Medicare PECOS PAC ID	9032271697
Medicare Enrollment ID	O20090305000400

Medical Identifiers

Medical identifiers for Fourth Street Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1528128899	NPI	-	NPPES
201375	Other	UT	BLACK LUNG
W0210	Medicaid	UT

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
261QF0400X	Clinic/center - Federally Qualified Health Center (fqhc)	(* (Not Available))	Primary

Reviews and Comments

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Fourth Street Clinic - Medicare Primary Care in Salt Lake City, UT