| |
East Highway 262 Montezuma Creek UT 84534 | |
(435) 651-3291 | |
(435) 651-3291 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | East Highway 262, Montezuma Creek, Utah |
Authorized Official Name and Position | Michael Jensen (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 4356513713 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 130 Montezuma Creek UT 84534 Ph: (435) 651-3291 | East Highway 262 Montezuma Creek UT 84534 Ph: (435) 651-3291 |
NPI Number | 1932386612 |
---|---|
Provider Enumeration Date | 01/25/2008 |
Last Update Date | 06/11/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932386612 | NPI | - | NPPES |
1811991151 | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |