| Ma Bo Inc | |
|
466 E 500 S Ste 200 Salt Lake City UT 84111-3350 | |
| (801) 485-5055 | |
| (801) 467-3296 |
| Full Name | Ma Bo Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 466 E 500 S Ste 200, Salt Lake City, Utah |
| Authorized Official Name and Position | Caitlin Danielle Cacciatore (OFFICE MANAGER) |
| Authorized Official Contact | 8014855055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ma Bo Inc 466 E 500 S Ste 200 Salt Lake City UT 84111-3350 Ph: (801) 485-5055 | Ma Bo Inc 466 E 500 S Ste 200 Salt Lake City UT 84111-3350 Ph: (801) 485-5055 |
| NPI Number | 1588185581 |
|---|---|
| Provider Enumeration Date | 06/29/2017 |
| Last Update Date | 07/19/2024 |
| Medicare PECOS PAC ID | 1254399652 |
|---|---|
| Medicare Enrollment ID | O20180322002649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588185581 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sandra B Jense |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104258763 PECOS PAC ID: 0941423404 Enrollment ID: I20180613002178 |
| Provider Name | Mark J Cacciamani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063500163 PECOS PAC ID: 9537057773 Enrollment ID: I20180815002622 |
| Provider Name | Rita Helen Rutland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396266177 PECOS PAC ID: 7719251438 Enrollment ID: I20190103000886 |
| Provider Name | Brandon Kruse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891308094 PECOS PAC ID: 2264847375 Enrollment ID: I20210224000574 |
| Provider Name | Samantha A Booth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609585199 PECOS PAC ID: 5597924563 Enrollment ID: I20230117001546 |
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