| Highland Family Practice | |
|
4460 Highland Dr Ste 400 Salt Lake City UT 84124-3565 | |
| (801) 272-4111 | |
| (801) 272-5989 |
| Full Name | Highland Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 4460 Highland Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Derek David Muse (MANAGER) |
| Authorized Official Contact | 8012724111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Highland Family Practice 4460 So Highland Dr #400 Salt Lake City UT 84124 Ph: (801) 272-4111 | Highland Family Practice 4460 Highland Dr Ste 400 Salt Lake City UT 84124-3565 Ph: (801) 272-4111 |
| NPI Number | 1215010327 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 03/10/2008 |
| Medicare PECOS PAC ID | 8022179894 |
|---|---|
| Medicare Enrollment ID | O20081211000619 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215010327 | NPI | - | NPPES |
| 528940093006 | Medicaid | UT |
| Provider Name | Amanda J Wirth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376612150 PECOS PAC ID: 1355394974 Enrollment ID: I20050223000755 |
| Provider Name | Derek D Muse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720157555 PECOS PAC ID: 9638083892 Enrollment ID: I20090115000104 |
| Provider Name | Brian Gary Drage |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932278785 PECOS PAC ID: 0840235354 Enrollment ID: I20230713001243 |
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