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157 N Paiute Dr Reservation Rd Kanosh UT 84637 | |
(435) 759-2610 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 157 N Paiute Dr Reservation Rd, Kanosh, Utah |
Authorized Official Name and Position | Tyler Prisbrey (CFO) |
Authorized Official Contact | 4355861112 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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440 N Paiute Dr Cedar City UT 84720-2681 Ph: (435) 586-1112 | 157 N Paiute Dr Reservation Rd Kanosh UT 84637 Ph: (435) 759-2610 |
NPI Number | 1992972525 |
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Provider Enumeration Date | 05/13/2008 |
Last Update Date | 02/22/2024 |
Medicare PECOS PAC ID | 3072414952 |
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Medicare Enrollment ID | O20150803000383 |
Identifier | Type | State | Issuer |
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1992972525 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |