| Granger Medical Clinic Pc | |
|
2965 W. 3500 S. West Valley City UT 84119 | |
| (801) 965-3600 | |
| Not Available |
| Full Name | Granger Medical Clinic Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2965 W. 3500 S., West Valley City, Utah |
| Authorized Official Name and Position | Mary Jane Pennington (PRESIDENT) |
| Authorized Official Contact | 8019653417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granger Medical Clinic Pc 2965 W 3500 S West Valley City UT 84119-3602 Ph: (801) 965-3600 | Granger Medical Clinic Pc 2965 W. 3500 S. West Valley City UT 84119 Ph: (801) 965-3600 |
| NPI Number | 1184657041 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 12/13/2023 |
| Medicare PECOS PAC ID | 3476465691 |
|---|---|
| Medicare Enrollment ID | O20031105000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184657041 | NPI | - | NPPES |
| Provider Name | Alan Young |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1588691380 PECOS PAC ID: 4486559325 Enrollment ID: I20031203000681 |
| Provider Name | Karen A Zempolich |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1841228525 PECOS PAC ID: 2062317910 Enrollment ID: I20031203000709 |
| Provider Name | Daniel Vernon Cahoon |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1013985522 PECOS PAC ID: 6103721964 Enrollment ID: I20031204000549 |
| Provider Name | Timothy C Hollingsed |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1790716181 PECOS PAC ID: 0941107247 Enrollment ID: I20031215000993 |
| Provider Name | Robert E Smith |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1578675633 PECOS PAC ID: 1658279435 Enrollment ID: I20031230000823 |
| Provider Name | William D Boam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659388791 PECOS PAC ID: 6507767951 Enrollment ID: I20040119000077 |
| Provider Name | David C Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679548564 PECOS PAC ID: 6709774540 Enrollment ID: I20040304001080 |
| Provider Name | Jon R Aoki |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1295805265 PECOS PAC ID: 7517850118 Enrollment ID: I20040309000318 |
| Provider Name | Jacqueline A Lobsiger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497774525 PECOS PAC ID: 6204822604 Enrollment ID: I20040421001632 |
| Provider Name | Jan B Bernhisel-broadbent |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1265487300 PECOS PAC ID: 5092704114 Enrollment ID: I20040512000269 |
| Provider Name | Kathryn Casull |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831256635 PECOS PAC ID: 3779568027 Enrollment ID: I20040621001408 |
| Provider Name | Alton D Burgett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124059514 PECOS PAC ID: 1658359187 Enrollment ID: I20040715000500 |
| Provider Name | Kenneth L Schaecher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245262492 PECOS PAC ID: 8820078801 Enrollment ID: I20040721000690 |
| Provider Name | Pinky Kotwal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083645444 PECOS PAC ID: 2466432463 Enrollment ID: I20040721000796 |
| Provider Name | Roy J Gandolfi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740211101 PECOS PAC ID: 4486634482 Enrollment ID: I20040721000838 |
| Provider Name | Sandeep Chowdhary |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1891726162 PECOS PAC ID: 5294715207 Enrollment ID: I20040721000853 |
| Provider Name | Robin G Mainwaring |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043276033 PECOS PAC ID: 9133189038 Enrollment ID: I20041014001058 |
| Provider Name | Kennon C Tubbs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700842804 PECOS PAC ID: 0143284299 Enrollment ID: I20041117001129 |
| Provider Name | Sheetal R Shah |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1841271491 PECOS PAC ID: 2668411018 Enrollment ID: I20050426000937 |
| Provider Name | Gary Blake Johnson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1144223827 PECOS PAC ID: 4789625690 Enrollment ID: I20050519001121 |
| Provider Name | Edwin R England |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417068313 PECOS PAC ID: 7911933254 Enrollment ID: I20050708000792 |
| Provider Name | Richard B Gremillion |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1205820693 PECOS PAC ID: 8224069067 Enrollment ID: I20050822001215 |
| Provider Name | Cathy J Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861402331 PECOS PAC ID: 4789615170 Enrollment ID: I20050825000485 |
| Provider Name | Michelle Elise Murday |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1184616468 PECOS PAC ID: 9739113598 Enrollment ID: I20050921000421 |
| Provider Name | Micah G Rosenfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194757336 PECOS PAC ID: 7719905256 Enrollment ID: I20051103000571 |
| Provider Name | Ronald E Brown |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1447242060 PECOS PAC ID: 1052309671 Enrollment ID: I20051115001132 |
| Provider Name | Randall R Fillmore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386675627 PECOS PAC ID: 5496778912 Enrollment ID: I20060111000426 |
| Provider Name | James R Grua |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1134159288 PECOS PAC ID: 1153344528 Enrollment ID: I20060111001003 |
| Provider Name | Todd R Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902917495 PECOS PAC ID: 3971527714 Enrollment ID: I20060119000890 |
| Provider Name | David Howard Oelsner |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1396760765 PECOS PAC ID: 7517976095 Enrollment ID: I20060411000485 |
| Provider Name | Peter C Fisher |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1902847940 PECOS PAC ID: 2668483975 Enrollment ID: I20060531000027 |
| Provider Name | Hu Ding |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1710923552 PECOS PAC ID: 0446265664 Enrollment ID: I20060801000077 |
| Provider Name | Kelly L Hamblin |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1770515926 PECOS PAC ID: 1456354125 Enrollment ID: I20060818000128 |
| Provider Name | Stephen B Devenport |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093730467 PECOS PAC ID: 2163425836 Enrollment ID: I20060818000154 |
| Provider Name | Mary Jane Pennington |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205868452 PECOS PAC ID: 4486566619 Enrollment ID: I20061207000281 |
| Provider Name | Stewart T Landau |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1174559728 PECOS PAC ID: 7911000963 Enrollment ID: I20070321000721 |
| Provider Name | Christopher V Hutchison |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1134151384 PECOS PAC ID: 7113025743 Enrollment ID: I20070606000090 |
| Provider Name | Richard William Hendershot |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1518916782 PECOS PAC ID: 9133126667 Enrollment ID: I20070705000290 |
| Provider Name | Bradley James Waterman |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1699718809 PECOS PAC ID: 9436240298 Enrollment ID: I20070808000277 |
| Provider Name | Charles R Davis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326136565 PECOS PAC ID: 5890887368 Enrollment ID: I20070829000038 |
| Provider Name | Ian R Cavin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184647315 PECOS PAC ID: 9234160318 Enrollment ID: I20070906000006 |
| Provider Name | Dana A Andersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578595724 PECOS PAC ID: 8628159852 Enrollment ID: I20080114000771 |
| Provider Name | Robert D Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063596401 PECOS PAC ID: 0749364941 Enrollment ID: I20080227000140 |
| Provider Name | Steve A Oliver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396720058 PECOS PAC ID: 6103995709 Enrollment ID: I20080522000374 |
| Provider Name | Michael S Connolly |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003014374 PECOS PAC ID: 5698844058 Enrollment ID: I20080527000583 |
| Provider Name | Tricia A Twelves |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1730389297 PECOS PAC ID: 7113092115 Enrollment ID: I20080826000123 |
| Provider Name | Daniel T Richards |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1649455403 PECOS PAC ID: 5193899607 Enrollment ID: I20090827000540 |
| Provider Name | Melisa S Steele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003923988 PECOS PAC ID: 1850438276 Enrollment ID: I20091016000344 |
| Provider Name | William O Brant |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1467478339 PECOS PAC ID: 2567468796 Enrollment ID: I20091130000045 |
| Provider Name | William H Burleigh |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1023040276 PECOS PAC ID: 9830239151 Enrollment ID: I20091217000548 |
| Provider Name | Brandon Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952333106 PECOS PAC ID: 4385723030 Enrollment ID: I20091217000579 |
| Provider Name | Scott Sheridan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578594925 PECOS PAC ID: 5890836340 Enrollment ID: I20100106000664 |
| Provider Name | David Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386676526 PECOS PAC ID: 7416098967 Enrollment ID: I20100106000686 |
| Provider Name | Dean N Walker |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1861424012 PECOS PAC ID: 6800988460 Enrollment ID: I20100119000729 |
| Provider Name | Cheryle Cutlip |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336171586 PECOS PAC ID: 9335281583 Enrollment ID: I20100126000572 |
| Provider Name | David George Dienhart |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1184601940 PECOS PAC ID: 4183768849 Enrollment ID: I20100218000213 |
| Provider Name | Sunny Pandita |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1023095809 PECOS PAC ID: 4284779158 Enrollment ID: I20100303000301 |
| Provider Name | Zaneta Bulaj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598869026 PECOS PAC ID: 7416082789 Enrollment ID: I20100312000201 |
| Provider Name | Thomas Barman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881704286 PECOS PAC ID: 9032244306 Enrollment ID: I20100312000222 |
| Provider Name | Jennifer L Norris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932210895 PECOS PAC ID: 8022143395 Enrollment ID: I20100312000233 |
| Provider Name | Daniel Yarrish |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235240110 PECOS PAC ID: 3870628159 Enrollment ID: I20100312000298 |
| Provider Name | Peter L Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992737159 PECOS PAC ID: 4284713934 Enrollment ID: I20100317000599 |
| Provider Name | Lane Clifford Childs |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1831239995 PECOS PAC ID: 9436119211 Enrollment ID: I20100715000884 |
| Provider Name | Michael J Sanderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215134663 PECOS PAC ID: 7911030457 Enrollment ID: I20100804000201 |
| Provider Name | Gregory S Anderson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992797492 PECOS PAC ID: 0941215610 Enrollment ID: I20100812000966 |
| Provider Name | Michael R Hinckley |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1760665707 PECOS PAC ID: 2567500523 Enrollment ID: I20100917000201 |
| Provider Name | Craig A Coleby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386825024 PECOS PAC ID: 1052493764 Enrollment ID: I20100923001486 |
| Provider Name | Barbara Hurst |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205973070 PECOS PAC ID: 7416858790 Enrollment ID: I20101101001393 |
| Provider Name | Michael Lamar Twede |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861450140 PECOS PAC ID: 9436159811 Enrollment ID: I20110307000340 |
| Provider Name | Layne Smith |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770693251 PECOS PAC ID: 1355529017 Enrollment ID: I20110628000332 |
| Provider Name | Angelo Pulgiano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952322836 PECOS PAC ID: 3577577980 Enrollment ID: I20110719000217 |
| Provider Name | Craig W Davis |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1861643330 PECOS PAC ID: 0840324794 Enrollment ID: I20110913000495 |
| Provider Name | Susan Prater |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841430733 PECOS PAC ID: 1850564626 Enrollment ID: I20111024000640 |
| Provider Name | Margaret Grogan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962669853 PECOS PAC ID: 7911167366 Enrollment ID: I20120322000465 |
| Provider Name | Robert W Later |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669567376 PECOS PAC ID: 9931360328 Enrollment ID: I20120411000649 |
| Provider Name | James Steven Robbins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720234412 PECOS PAC ID: 7719134733 Enrollment ID: I20120827000860 |
| Provider Name | Casey J Henich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003041740 PECOS PAC ID: 6608023577 Enrollment ID: I20120828000638 |
| Provider Name | Christian Layne Sybrowsky |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1710099676 PECOS PAC ID: 2264689751 Enrollment ID: I20120906000582 |
| Provider Name | Nathan C Littlefield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568747707 PECOS PAC ID: 5799933982 Enrollment ID: I20120912000895 |
| Provider Name | Matthew S Wilson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1750543955 PECOS PAC ID: 2466600580 Enrollment ID: I20120914000589 |
| Provider Name | Mark W Nevers |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1366704959 PECOS PAC ID: 3274785316 Enrollment ID: I20121218000292 |
| Provider Name | Bruce C Depew |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376505214 PECOS PAC ID: 3779624879 Enrollment ID: I20121231000132 |
| Provider Name | Katherine Ward Munt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982867008 PECOS PAC ID: 2163600982 Enrollment ID: I20130111000029 |
| Provider Name | James S Mcintyre |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1043446602 PECOS PAC ID: 9739339524 Enrollment ID: I20130918000811 |
| Provider Name | Ashleigh A Byrne |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1023269537 PECOS PAC ID: 8022289842 Enrollment ID: I20140130001025 |
| Provider Name | James R Meadows |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285892968 PECOS PAC ID: 0840425641 Enrollment ID: I20141007000408 |
| Provider Name | Susan R Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689777690 PECOS PAC ID: 7911972898 Enrollment ID: I20141021003233 |
| Provider Name | Jonathan Ashton Olsen |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1518287846 PECOS PAC ID: 0042475824 Enrollment ID: I20150407000751 |
| Provider Name | Abby N Crume |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1285868059 PECOS PAC ID: 0143456897 Enrollment ID: I20150921002895 |
| Provider Name | Javier Eduardo Chavez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295020949 PECOS PAC ID: 6305156738 Enrollment ID: I20151113001815 |
| Provider Name | James R Craig |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1730474792 PECOS PAC ID: 8325270093 Enrollment ID: I20160329002767 |
| Provider Name | Peter Caputo |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1992050041 PECOS PAC ID: 7214154020 Enrollment ID: I20160511002003 |
| Provider Name | Sean Jay Henderson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1366753709 PECOS PAC ID: 5597086280 Enrollment ID: I20160713002253 |
| Provider Name | Rebekah Clifford |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1053511584 PECOS PAC ID: 4486949377 Enrollment ID: I20160816002499 |
| Provider Name | Cuper Martinez Santibanez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891238481 PECOS PAC ID: 0749557130 Enrollment ID: I20170607000686 |
| Provider Name | Stephanie D Henderson |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1982997284 PECOS PAC ID: 5991074940 Enrollment ID: I20170706001586 |
| Provider Name | Alison E Oakes |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1639460470 PECOS PAC ID: 8527298710 Enrollment ID: I20170815002529 |
| Provider Name | Wayne Berg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851813299 PECOS PAC ID: 4688946262 Enrollment ID: I20170816002606 |
| Provider Name | Ryan Leonard |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1649460163 PECOS PAC ID: 7810073988 Enrollment ID: I20170828004629 |
| Provider Name | Katherine G Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710912738 PECOS PAC ID: 6204194053 Enrollment ID: I20171227002301 |
| Provider Name | Sean D Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497142582 PECOS PAC ID: 1951609544 Enrollment ID: I20180601002320 |
| Provider Name | Jordan Roberts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588043871 PECOS PAC ID: 8426354994 Enrollment ID: I20180611001538 |
| Provider Name | Corey Neerings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578040465 PECOS PAC ID: 4789936584 Enrollment ID: I20181005000800 |
| Provider Name | Karen M Waskowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114449576 PECOS PAC ID: 8628340023 Enrollment ID: I20181019002169 |
| Provider Name | Komal Rastogi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063774669 PECOS PAC ID: 4082906342 Enrollment ID: I20190102001980 |
| Provider Name | Brandie Blood Rudy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417435199 PECOS PAC ID: 1658619333 Enrollment ID: I20190206000005 |
| Provider Name | Joshua Streeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649755349 PECOS PAC ID: 1052659257 Enrollment ID: I20190213003142 |
| Provider Name | Joshua David Holyoak |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1407071665 PECOS PAC ID: 0244472702 Enrollment ID: I20190318002484 |
| Provider Name | Michelle D Looye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639554199 PECOS PAC ID: 5496088494 Enrollment ID: I20190606000927 |
| Provider Name | Joseph Conor Melvin |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1942640420 PECOS PAC ID: 3072747153 Enrollment ID: I20190912002792 |
| Provider Name | Emily Lailhengue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215450648 PECOS PAC ID: 4082042817 Enrollment ID: I20200310001061 |
| Provider Name | William Warner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265403463 PECOS PAC ID: 6800085317 Enrollment ID: I20200428000462 |
| Provider Name | Juan Martinez-ross |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720139538 PECOS PAC ID: 9638484793 Enrollment ID: I20200513001923 |
| Provider Name | Jonathan Michael Neilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780236109 PECOS PAC ID: 7618397217 Enrollment ID: I20201021000570 |
| Provider Name | Elizabeth Elouise Willmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730788761 PECOS PAC ID: 5193135267 Enrollment ID: I20201030000362 |
| Provider Name | Eric Grover |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174801179 PECOS PAC ID: 3375865199 Enrollment ID: I20201103001215 |
| Provider Name | Chad Harston |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1649260910 PECOS PAC ID: 9739186503 Enrollment ID: I20210120002171 |
| Provider Name | Andrew Swenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174012934 PECOS PAC ID: 8820491335 Enrollment ID: I20210721002489 |
| Provider Name | Tyler T Wood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962994962 PECOS PAC ID: 4880014281 Enrollment ID: I20210730001696 |
| Provider Name | Katherine L Peacock |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013449123 PECOS PAC ID: 8628322443 Enrollment ID: I20210809001640 |
| Provider Name | Cassie L Port |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912671272 PECOS PAC ID: 4587069406 Enrollment ID: I20210816002370 |
| Provider Name | Katie Rousseau Jeans |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093151862 PECOS PAC ID: 4981933447 Enrollment ID: I20210823000666 |
| Provider Name | Adrianne F Shewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467062570 PECOS PAC ID: 8426447533 Enrollment ID: I20211111000645 |
| Provider Name | Erin Batin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245780808 PECOS PAC ID: 7214351592 Enrollment ID: I20220321001786 |
| Provider Name | Nathan Pursifull |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1619161007 PECOS PAC ID: 8729216205 Enrollment ID: I20220603001705 |
| Provider Name | Brandon S Childs |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1659721199 PECOS PAC ID: 8820478621 Enrollment ID: I20220711003386 |
| Provider Name | Monica Hinz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669977880 PECOS PAC ID: 5890196521 Enrollment ID: I20220824000119 |
| Provider Name | Kimball Tyson Bailey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073176400 PECOS PAC ID: 0042694010 Enrollment ID: I20220825002092 |
| Provider Name | Geeta Nagpal |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1386838183 PECOS PAC ID: 3375739600 Enrollment ID: I20221013002162 |
| Provider Name | Alexis Lauren Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538736731 PECOS PAC ID: 7416325394 Enrollment ID: I20221128000587 |
| Provider Name | Emily Anne Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982284873 PECOS PAC ID: 0042689770 Enrollment ID: I20221219002913 |
| Provider Name | Lehai Lily Austin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093469116 PECOS PAC ID: 6608241393 Enrollment ID: I20230411002396 |
| Provider Name | Chase K Christensen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1649894569 PECOS PAC ID: 2961825088 Enrollment ID: I20230518000423 |
| Provider Name | Curtis R Gapinski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184945024 PECOS PAC ID: 3678990454 Enrollment ID: I20230608000465 |
| Provider Name | Steven Stoker |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1194264374 PECOS PAC ID: 2769752815 Enrollment ID: I20230803003998 |
| Provider Name | Matthew Bobel |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1851788046 PECOS PAC ID: 3476858630 Enrollment ID: I20230831002043 |
| Provider Name | Stacey Mills Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154003473 PECOS PAC ID: 0749643039 Enrollment ID: I20230905001693 |
| Provider Name | Kristen Gulock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033994470 PECOS PAC ID: 2062876998 Enrollment ID: I20230912000885 |
| Provider Name | Aubrey Rochelle George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083315220 PECOS PAC ID: 0446614242 Enrollment ID: I20230912004370 |
| Provider Name | Alexandra N. Twitchell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932738887 PECOS PAC ID: 7618372616 Enrollment ID: I20230925001748 |
| Provider Name | Jay Page |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1639229016 PECOS PAC ID: 4880768258 Enrollment ID: I20231031003130 |
| Provider Name | Michelle Dieter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093146003 PECOS PAC ID: 6709004898 Enrollment ID: I20240208000659 |
| Provider Name | Alyson Eyre |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508897927 PECOS PAC ID: 7517302011 Enrollment ID: I20240223002160 |
Vamos Health Ut Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3725 W 4100 S Ste 107, West Valley City, UT 84120 Phone: 502-333-2281 | |
Molina Medical Group Of Southern California Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2196 West 3500 South, Suite C1, West Valley City, UT 84119 Phone: 562-499-6191 Fax: 562-499-6171 | |
Granite Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4163 S 3200 W, West Valley City, UT 84119 Phone: 801-964-9355 Fax: 801-967-2692 | |
3 Form - West Valley City Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2300 S 2300 W Ste B, West Valley City, UT 84119 Phone: 801-975-7505 | |
Gastroenterology West Valley Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3336 S 4155 W, Ste 306, West Valley City, UT 84120 Phone: 901-964-3855 Fax: 801-208-6367 | |
West Valley Specialty Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5373 W Lake Park Blvd, West Valley City, UT 84127 Phone: 801-442-1853 | |
Healing Center Of Utah Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2630 W 3500 S Ste B, West Valley City, UT 84119 Phone: 801-955-8888 Fax: 801-955-8889 |