| Jordan Ridge Family Medicine Llc | |
|
6321 S Redwood Rd Ste 201 Salt Lake City UT 84123-6798 | |
| (801) 265-2212 | |
| (801) 265-0103 |
| Full Name | Jordan Ridge Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6321 S Redwood Rd, Salt Lake City, Utah |
| Authorized Official Name and Position | Emily D Castillo (MEDICAL STAFF MANAGER) |
| Authorized Official Contact | 7024802550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Ridge Family Medicine Llc 6321 S Redwood Rd Suite 201 Salt Lake City UT 84123-6798 Ph: (801) 265-2212 | Jordan Ridge Family Medicine Llc 6321 S Redwood Rd Ste 201 Salt Lake City UT 84123-6798 Ph: (801) 265-2212 |
| NPI Number | 1770509754 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 07/31/2023 |
| Medicare PECOS PAC ID | 8820091473 |
|---|---|
| Medicare Enrollment ID | O20060821000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770509754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kevin L Gardner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790897452 PECOS PAC ID: 9931135266 Enrollment ID: I20050708000700 |
| Provider Name | Mark Dale Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184668659 PECOS PAC ID: 6406872803 Enrollment ID: I20051014000515 |
| Provider Name | Diane Kendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659397545 PECOS PAC ID: 5294730552 Enrollment ID: I20060921000049 |
| Provider Name | David E Butters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932272598 PECOS PAC ID: 7113011032 Enrollment ID: I20070921000521 |
| Provider Name | Douglas M Vogeler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790869550 PECOS PAC ID: 1850466566 Enrollment ID: I20080814000585 |
| Provider Name | Jeffery L Degrauw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780796441 PECOS PAC ID: 1951391655 Enrollment ID: I20101025000677 |
| Provider Name | Courtney R Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205915410 PECOS PAC ID: 6709941339 Enrollment ID: I20120823000365 |
| Provider Name | Jennifer Beyer Jenkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891125100 PECOS PAC ID: 6204066756 Enrollment ID: I20140312001244 |
| Provider Name | John Michael Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902154172 PECOS PAC ID: 9638498975 Enrollment ID: I20160920002072 |
| Provider Name | Andrew Brice Heinecke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447819974 PECOS PAC ID: 1850628124 Enrollment ID: I20190808002796 |
| Provider Name | Natalie Angelica Solis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053953778 PECOS PAC ID: 8527495233 Enrollment ID: I20200218003171 |
| Provider Name | Steven G Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629030838 PECOS PAC ID: 6406877000 Enrollment ID: I20210107002513 |
| Provider Name | Son Trung Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962031138 PECOS PAC ID: 1355761867 Enrollment ID: I20230502002605 |
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