| Midtown Community Health Center Inc | |
|
2240 Adams Ave Ogden UT 84401-1511 | |
| (801) 393-5355 | |
| (801) 394-4609 |
| Full Name | Midtown Community Health Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2240 Adams Ave, Ogden, Utah |
| Authorized Official Name and Position | Lisa M Nichols (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8013342213 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midtown Community Health Center Inc 2240 Adams Ave Ogden UT 84401-1511 Ph: (801) 393-5355 | Midtown Community Health Center Inc 2240 Adams Ave Ogden UT 84401-1511 Ph: (801) 393-5355 |
| NPI Number | 1548267420 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0345135414 |
|---|---|
| Medicare Enrollment ID | O20040218000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548267420 | NPI | - | NPPES |
| 870540037009 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 00867511 (Utah) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Mark D Housley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457358335 PECOS PAC ID: 6406754993 Enrollment ID: I20031222000430 |
| Provider Name | Teresa Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922004209 PECOS PAC ID: 9739172073 Enrollment ID: I20040405000513 |
| Provider Name | Tiffanie A Haun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659348159 PECOS PAC ID: 6002835964 Enrollment ID: I20051121000431 |
| Provider Name | Richard J Gregoire |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528066149 PECOS PAC ID: 4587688734 Enrollment ID: I20060116000111 |
| Provider Name | Nathan M Hadley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265440713 PECOS PAC ID: 1658479142 Enrollment ID: I20070606000739 |
| Provider Name | Stanley T Graham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326230921 PECOS PAC ID: 7911092135 Enrollment ID: I20071003000524 |
| Provider Name | Jack Crosland |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1750373247 PECOS PAC ID: 1254239759 Enrollment ID: I20081208000642 |
| Provider Name | Carissa S Monroy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760610349 PECOS PAC ID: 9830236819 Enrollment ID: I20091023000170 |
| Provider Name | Scott Rex Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982913679 PECOS PAC ID: 1052583465 Enrollment ID: I20111007000116 |
| Provider Name | Darrin W Tuckett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447696133 PECOS PAC ID: 6103049697 Enrollment ID: I20140602002198 |
| Provider Name | Kurt E Rifleman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780682567 PECOS PAC ID: 6709800972 Enrollment ID: I20150602000135 |
| Provider Name | John Benjamin Dame |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922205947 PECOS PAC ID: 1456445618 Enrollment ID: I20160601002995 |
| Provider Name | Taylor Swenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245696913 PECOS PAC ID: 8426335415 Enrollment ID: I20170428001489 |
| Provider Name | Valeria F Dias |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578980629 PECOS PAC ID: 6002189842 Enrollment ID: I20170830001777 |
| Provider Name | Tyler G Coe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437533270 PECOS PAC ID: 7214244391 Enrollment ID: I20190410002414 |
| Provider Name | Ty J Mccomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164813184 PECOS PAC ID: 3678884517 Enrollment ID: I20200921001725 |
| Provider Name | Alex Suarez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083807630 PECOS PAC ID: 4385805381 Enrollment ID: I20201006000345 |
| Provider Name | Brandi Lee Foree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881202323 PECOS PAC ID: 6002257482 Enrollment ID: I20240516001224 |
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