| Montezuma Creek Community Health Center | |
|
1478 East Highway 162 Montezuma Creek UT 84534 | |
| (435) 651-3766 | |
| (435) 651-3376 |
| Full Name | Montezuma Creek Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1478 East Highway 162, Montezuma Creek, Utah |
| Authorized Official Name and Position | Andrew Evans (CFO) |
| Authorized Official Contact | 4356513716 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montezuma Creek Community Health Center Po Box 130 Montezuma Creek UT 84534-0130 Ph: (435) 651-3766 | Montezuma Creek Community Health Center 1478 East Highway 162 Montezuma Creek UT 84534 Ph: (435) 651-3766 |
| NPI Number | 1811991151 |
|---|---|
| Provider Enumeration Date | 06/01/2005 |
| Last Update Date | 04/14/2023 |
| Medicare PECOS PAC ID | 1658275649 |
|---|---|
| Medicare Enrollment ID | O20031121000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811991151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | FQHC NOT REQUIRED (Utah) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Lloyd V Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932102514 PECOS PAC ID: 0749184745 Enrollment ID: I20031121000272 |
| Provider Name | Sterling P Black |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1699725747 PECOS PAC ID: 4880591056 Enrollment ID: I20031216000424 |
| Provider Name | Pamela A Hansen |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1649360249 PECOS PAC ID: 5698676088 Enrollment ID: I20040119000291 |
| Provider Name | Brooks D Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487657763 PECOS PAC ID: 0941271670 Enrollment ID: I20040804001667 |
| Provider Name | Terry R Cook |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1285636449 PECOS PAC ID: 2062404023 Enrollment ID: I20041001000400 |
| Provider Name | Wendell G Key |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588733729 PECOS PAC ID: 5890718670 Enrollment ID: I20060106000622 |
| Provider Name | Roselyn Maryboy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053324665 PECOS PAC ID: 5698771079 Enrollment ID: I20061006000341 |
| Provider Name | Kimberly J Fairley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235214289 PECOS PAC ID: 4981605045 Enrollment ID: I20070117000076 |
| Provider Name | Richard T Ward |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144223413 PECOS PAC ID: 3173628716 Enrollment ID: I20070410000554 |
| Provider Name | Deirdre Piotrowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609879998 PECOS PAC ID: 6103923297 Enrollment ID: I20070524000493 |
| Provider Name | Stephanie Zone |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1124233242 PECOS PAC ID: 7719088434 Enrollment ID: I20070725000539 |
| Provider Name | Alan K Ward |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811965817 PECOS PAC ID: 0840391488 Enrollment ID: I20070730000054 |
| Provider Name | Anwar Tandar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1154538148 PECOS PAC ID: 1456446756 Enrollment ID: I20071002000305 |
| Provider Name | Arlan M Henrie |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1235168592 PECOS PAC ID: 6406933217 Enrollment ID: I20080403000322 |
| Provider Name | Joshua H Nielson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699776922 PECOS PAC ID: 5890719579 Enrollment ID: I20091211000236 |
| Provider Name | Ravi Ranjan |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1467505206 PECOS PAC ID: 0547328627 Enrollment ID: I20101006000550 |
| Provider Name | Manish Pandya |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1326145392 PECOS PAC ID: 6002848900 Enrollment ID: I20101116000885 |
| Provider Name | Mrugendra M. Gandhi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1528050978 PECOS PAC ID: 6901856939 Enrollment ID: I20110808000673 |
| Provider Name | Russell B Pincock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356636443 PECOS PAC ID: 8123290962 Enrollment ID: I20111020000409 |
| Provider Name | Terri Hancock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245510536 PECOS PAC ID: 5890968077 Enrollment ID: I20111103000505 |
| Provider Name | Ronald Dean Kirk |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1780623595 PECOS PAC ID: 5092982660 Enrollment ID: I20120209000693 |
| Provider Name | Alton R Pugh |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477885994 PECOS PAC ID: 0446386023 Enrollment ID: I20120813000341 |
| Provider Name | Phillip L Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245592427 PECOS PAC ID: 0143478529 Enrollment ID: I20120910000045 |
| Provider Name | Casey K Mccullough |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902127350 PECOS PAC ID: 7517109069 Enrollment ID: I20130812000841 |
| Provider Name | Benjamin W Carelock |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992949481 PECOS PAC ID: 0840434270 Enrollment ID: I20131014000742 |
| Provider Name | Irene Cheong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093115289 PECOS PAC ID: 2769705904 Enrollment ID: I20141219001423 |
| Provider Name | William A Cuskelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003882531 PECOS PAC ID: 2668467390 Enrollment ID: I20150413002246 |
| Provider Name | Shane Beeton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497159487 PECOS PAC ID: 4789903501 Enrollment ID: I20150429001305 |
| Provider Name | Sandra Spackman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164892592 PECOS PAC ID: 0749580009 Enrollment ID: I20151118002680 |
| Provider Name | Crystal Sekaquaptewa |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255730701 PECOS PAC ID: 7911291299 Enrollment ID: I20160809002270 |
| Provider Name | Paul Goodrich |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508218330 PECOS PAC ID: 0345534350 Enrollment ID: I20160812001260 |
| Provider Name | Paul R Macdonald |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1265606297 PECOS PAC ID: 3274829940 Enrollment ID: I20160906001572 |
| Provider Name | Christopher A. Mccaffrey-boss |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1073709440 PECOS PAC ID: 4880980572 Enrollment ID: I20160906002480 |
| Provider Name | Hal Bawden |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1104129550 PECOS PAC ID: 2163728551 Enrollment ID: I20160907001707 |
| Provider Name | Brian Goodwine |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891857223 PECOS PAC ID: 1557657640 Enrollment ID: I20160916000715 |
| Provider Name | Brian Frederick Olsen |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1457344566 PECOS PAC ID: 6103122114 Enrollment ID: I20160921001141 |
| Provider Name | Patricia Spencer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033347562 PECOS PAC ID: 4880848894 Enrollment ID: I20170309002108 |
| Provider Name | Christy L Kopasz |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1174901367 PECOS PAC ID: 9335425388 Enrollment ID: I20170406000744 |
| Provider Name | Alan Quin Wygant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205318227 PECOS PAC ID: 3173876992 Enrollment ID: I20181024003339 |
| Provider Name | Lewis Adamson Black |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1518026012 PECOS PAC ID: 4183691587 Enrollment ID: I20181025001653 |
| Provider Name | Leslie Mcnaughtan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902347172 PECOS PAC ID: 3577802917 Enrollment ID: I20190304000477 |
| Provider Name | Mindy Rae Gurley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053899690 PECOS PAC ID: 3870845241 Enrollment ID: I20190307002981 |
| Provider Name | Brent L Griffin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023038114 PECOS PAC ID: 3476538166 Enrollment ID: I20190522001663 |
| Provider Name | Kindra Karoline Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902436611 PECOS PAC ID: 2264861624 Enrollment ID: I20200406001889 |
| Provider Name | Dane Phillip Lyman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588227797 PECOS PAC ID: 6406266675 Enrollment ID: I20201029002881 |
| Provider Name | Dominick Ruybal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811428048 PECOS PAC ID: 9638412455 Enrollment ID: I20201104003004 |
| Provider Name | Stephen Rex Burton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063865566 PECOS PAC ID: 6002194792 Enrollment ID: I20210107002182 |
| Provider Name | Janae Kinikin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1881248698 PECOS PAC ID: 8628483559 Enrollment ID: I20210226000515 |
| Provider Name | Swayzee Ramage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235627936 PECOS PAC ID: 3072867324 Enrollment ID: I20210614001188 |
| Provider Name | Christine L Schulte |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1649820697 PECOS PAC ID: 9638503147 Enrollment ID: I20220316003134 |
| Provider Name | Emilie J Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902531601 PECOS PAC ID: 9739540352 Enrollment ID: I20230731000363 |
| Provider Name | Maverik Nicholas Shumway |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063117893 PECOS PAC ID: 5395109425 Enrollment ID: I20230907004049 |
Montezuma Creek Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: East Highway 262, Montezuma Creek, UT 84534 Phone: 435-651-3291 Fax: 435-651-3291 |