| In Home Provider | |
|
2432 Concord Ave Santa Clara UT 84765-5621 | |
| (435) 659-7352 | |
| Not Available |
| Full Name | In Home Provider |
|---|---|
| Speciality | Family Medicine |
| Location | 2432 Concord Ave, Santa Clara, Utah |
| Authorized Official Name and Position | Shane Whittier (COO) |
| Authorized Official Contact | 4357098786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| In Home Provider 387 W 100 S Heber City UT 84032-1835 Ph: (435) 671-3285 | In Home Provider 2432 Concord Ave Santa Clara UT 84765-5621 Ph: (435) 659-7352 |
| NPI Number | 1871131623 |
|---|---|
| Provider Enumeration Date | 12/11/2019 |
| Last Update Date | 12/11/2019 |
| Medicare PECOS PAC ID | 8628494382 |
|---|---|
| Medicare Enrollment ID | O20200812003296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871131623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Danica Anne Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881020030 PECOS PAC ID: 3072738749 Enrollment ID: I20140714001600 |
| Provider Name | Elisa Ann Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831558204 PECOS PAC ID: 0749585123 Enrollment ID: I20160223000901 |
| Provider Name | Megan Marie Western |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568077584 PECOS PAC ID: 4688080245 Enrollment ID: I20210304002474 |