| Monogram Health Professional Services Of Utah Pllc | |
|
222 S Main St Fl 5 Salt Lake City UT 84101-2185 | |
| (615) 673-4455 | |
| Not Available |
| Full Name | Monogram Health Professional Services Of Utah Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 222 S Main St Fl 5, Salt Lake City, Utah |
| Authorized Official Name and Position | Shawn Verner (GENERAL COUNSEL) |
| Authorized Official Contact | 6156734555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monogram Health Professional Services Of Utah Pllc 5410 Maryland Way Ste 301 Brentwood TN 37027-5339 Ph: (615) 673-4455 | Monogram Health Professional Services Of Utah Pllc 222 S Main St Fl 5 Salt Lake City UT 84101-2185 Ph: (615) 673-4455 |
| NPI Number | 1922714633 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 03/24/2023 |
| Medicare PECOS PAC ID | 0446625958 |
|---|---|
| Medicare Enrollment ID | O20230417000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922714633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Primary |
| Provider Name | Carrie R Hyde |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1114260726 PECOS PAC ID: 1658696307 Enrollment ID: I20230424001187 |
| Provider Name | Roshan D Rajani |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1336494145 PECOS PAC ID: 2567785694 Enrollment ID: I20230519001671 |
| Provider Name | Sahar Semnani |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1568985737 PECOS PAC ID: 4486927233 Enrollment ID: I20240207000723 |
| Provider Name | Annette K Stevenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558875435 PECOS PAC ID: 5799036315 Enrollment ID: I20240327001039 |
| Provider Name | Hilda Deen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538778543 PECOS PAC ID: 5294145652 Enrollment ID: I20240416002805 |
| Provider Name | Monica R Escobedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336779081 PECOS PAC ID: 0345647574 Enrollment ID: I20240606001109 |
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