| Main Street Family Medicine Pllc | |
|
571 East Main Street Enterprise UT 84725 | |
| (435) 878-5711 | |
| Not Available |
| Full Name | Main Street Family Medicine Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 571 East Main Street, Enterprise, Utah |
| Authorized Official Name and Position | Colten Dirk Bracken (MD/OWNER) |
| Authorized Official Contact | 4358785711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Medicine Pllc 571 East Main Street Enterprise UT 84725 Ph: (435) 878-5711 | Main Street Family Medicine Pllc 571 East Main Street Enterprise UT 84725 Ph: (435) 878-5711 |
| NPI Number | 1518636844 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 10/29/2021 |
| Medicare PECOS PAC ID | 0547650962 |
|---|---|
| Medicare Enrollment ID | O20211129001703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518636844 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Colten Bracken |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073993283 PECOS PAC ID: 6709172968 Enrollment ID: I20160914001810 |
| Provider Name | Kody Keith Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316533698 PECOS PAC ID: 1850781774 Enrollment ID: I20211208003614 |
Enterprise Valley Medical Clinic, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 223 South 200 East, Enterprise, UT 84725 Phone: 435-878-2281 Fax: 435-878-2434 |