| Living Tree Medical Group | |
|
169 N Gateway Dr Ste 170 Providence UT 84332-9855 | |
| (435) 565-6043 | |
| (435) 215-4420 |
| Full Name | Living Tree Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 169 N Gateway Dr Ste 170, Providence, Utah |
| Authorized Official Name and Position | Kris Coleman (COC) |
| Authorized Official Contact | 4357702131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Tree Medical Group 169 N Gateway Dr Ste 170 Providence UT 84332-9855 Ph: (435) 565-6043 | Living Tree Medical Group 169 N Gateway Dr Ste 170 Providence UT 84332-9855 Ph: (435) 565-6043 |
| NPI Number | 1639754583 |
|---|---|
| Provider Enumeration Date | 03/12/2021 |
| Last Update Date | 12/12/2023 |
| Medicare PECOS PAC ID | 5294128963 |
|---|---|
| Medicare Enrollment ID | O20220202001670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639754583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Gordon S Wood |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1255328969 PECOS PAC ID: 1052334588 Enrollment ID: I20060110000898 |
| Provider Name | Matthew J Welter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164486064 PECOS PAC ID: 3274426374 Enrollment ID: I20060113000864 |
| Provider Name | Kevin R Duke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003882713 PECOS PAC ID: 8820028673 Enrollment ID: I20111219000058 |
| Provider Name | John David Malouf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992097612 PECOS PAC ID: 3779700042 Enrollment ID: I20160601000164 |
| Provider Name | Jennifer Carter Mosteller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801356530 PECOS PAC ID: 7810230158 Enrollment ID: I20190530000079 |
| Provider Name | Savannah Alder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811519085 PECOS PAC ID: 2567882665 Enrollment ID: I20201012000590 |
| Provider Name | Justen Watkins |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689090060 PECOS PAC ID: 0941584254 Enrollment ID: I20240513001894 |
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Cache Valley Community Health Center - Providence Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 517 W 100 N Ste 110, Providence, UT 84332 Phone: 435-755-6075 Fax: 435-994-8362 | |
Peachtree Family Medicine Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 565 W 465 N Ste 130, Providence, UT 84332 Phone: 435-752-5553 Fax: 435-755-5043 | |
Foot & Ankle Center Of Cache Valley Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 435 N Gateway Dr Ste 801, Providence, UT 84332 Phone: 435-787-1023 Fax: 435-787-1883 |