| Medallus Medical | |
|
1126 E 12300 S Draper UT 84020-9095 | |
| (801) 545-0600 | |
| (801) 545-0626 |
| Full Name | Medallus Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1126 E 12300 S, Draper, Utah |
| Authorized Official Name and Position | Monique S Aragon (COMPLIANCE ADMIN ASST/ CRED LIAISON) |
| Authorized Official Contact | 8012601919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medallus Medical Po Box 95970 South Jordan UT 84095-0970 Ph: (801) 352-9500 | Medallus Medical 1126 E 12300 S Draper UT 84020-9095 Ph: (801) 545-0600 |
| NPI Number | 1437251279 |
|---|---|
| Provider Enumeration Date | 09/02/2006 |
| Last Update Date | 07/22/2024 |
| Medicare PECOS PAC ID | 8123926904 |
|---|---|
| Medicare Enrollment ID | O20031230000815 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437251279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Rachot K Vacharothone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548228497 PECOS PAC ID: 9931013745 Enrollment ID: I20031117000317 |
| Provider Name | Lisa M Anderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083679989 PECOS PAC ID: 7618991456 Enrollment ID: I20060119000883 |
| Provider Name | Carlos A Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215376587 PECOS PAC ID: 4082846795 Enrollment ID: I20140411001102 |
| Provider Name | David Joshua Brockbank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710222310 PECOS PAC ID: 8123246865 Enrollment ID: I20140821002166 |
| Provider Name | Terracina Fischer Zitting |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225799869 PECOS PAC ID: 5799140935 Enrollment ID: I20230424000859 |
| Provider Name | Jennifer Christine Oleskowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053015735 PECOS PAC ID: 6608233093 Enrollment ID: I20230530002059 |
| Provider Name | Hailey B Yamashiro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881324044 PECOS PAC ID: 8325409634 Enrollment ID: I20230803000288 |
| Provider Name | Mckinsey Owen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932982998 PECOS PAC ID: 4880038017 Enrollment ID: I20240215003398 |
| Provider Name | Gabriella Hayes Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093571564 PECOS PAC ID: 7214375484 Enrollment ID: I20240406000454 |
| Provider Name | Aubrey Noelle Snelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235997032 PECOS PAC ID: 6709228752 Enrollment ID: I20240522004044 |
| Provider Name | Aleczander M Rodriquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134764970 PECOS PAC ID: 4981146321 Enrollment ID: I20240612004132 |
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