| Green River Medical Center Inc | |
|
585 West Main St. Box 417 Green River UT 84525-0417 | |
| (435) 564-3434 | |
| (435) 564-3214 |
| Full Name | Green River Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 585 West Main St., Green River, Utah |
| Authorized Official Name and Position | Mary B Winters (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4355643434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green River Medical Center Inc 585 West Main St. Box 417 Green River UT 84525-0417 Ph: (435) 564-3434 | Green River Medical Center Inc 585 West Main St. Box 417 Green River UT 84525-0417 Ph: (435) 564-3434 |
| NPI Number | 1942317722 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 3870525843 |
|---|---|
| Medicare Enrollment ID | O20050910000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942317722 | NPI | - | NPPES |
| 572622038001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Glori Allen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801824297 PECOS PAC ID: 8820981657 Enrollment ID: I20040205000637 |
| Provider Name | Bryce Kay Warr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114453826 PECOS PAC ID: 3779905203 Enrollment ID: I20200629003708 |