| Hyrum Medical Clinic | |
|
26 W Main St # 3a Hyrum UT 84319-1206 | |
| (435) 245-6248 | |
| (435) 213-9882 |
| Full Name | Hyrum Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 26 W Main St # 3a, Hyrum, Utah |
| Authorized Official Name and Position | Kamie Prior (OFFICE MANAGER) |
| Authorized Official Contact | 4352456248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hyrum Medical Clinic 26 W Main St Ste 3a Hyrum UT 84319-1206 Ph: (435) 245-6248 | Hyrum Medical Clinic 26 W Main St # 3a Hyrum UT 84319-1206 Ph: (435) 245-6248 |
| NPI Number | 1184271215 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 08/10/2021 |
| Medicare PECOS PAC ID | 1153755384 |
|---|---|
| Medicare Enrollment ID | O20191223000550 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184271215 | NPI | - | NPPES |
| 1033156849 | Other | UT | BRANT FONNESBECK DO |
| 1184271215 | Other | UT | GROUP NPI |
| 1699322693 | Other | UT | CASSIE MILLIGAN NP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brant Wahlen Fonnesbeck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033156849 PECOS PAC ID: 3274558564 Enrollment ID: I20051005001126 |
| Provider Name | Cassie Milligan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699322693 PECOS PAC ID: 2961836101 Enrollment ID: I20191224000053 |
| Provider Name | Taylor Ann Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609443399 PECOS PAC ID: 7113312646 Enrollment ID: I20220321001651 |