| Amg Senior Medical Group | |
|
434 W Ascension Way Ste 225 Murray UT 84123 | |
| (801) 716-7008 | |
| (888) 990-1557 |
| Full Name | Amg Senior Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 434 W Ascension Way Ste 225, Murray, Utah |
| Authorized Official Name and Position | Nathan Blasier (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8017167008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amg Senior Medical Group 434 W Ascension Way Ste 225 Murray UT 84123-2790 Ph: (801) 716-7008 | Amg Senior Medical Group 434 W Ascension Way Ste 225 Murray UT 84123 Ph: (801) 716-7008 |
| NPI Number | 1487836532 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 03/07/2024 |
| Medicare PECOS PAC ID | 5991606329 |
|---|---|
| Medicare Enrollment ID | O20040117000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487836532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 311210-1205 (Utah) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Justin Wade Mansfield |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699707059 PECOS PAC ID: 4082654124 Enrollment ID: I20050506000782 |
| Provider Name | Alisha A Richins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679974968 PECOS PAC ID: 7719201946 Enrollment ID: I20150119000055 |
| Provider Name | Christine Ruthanne Slack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457898876 PECOS PAC ID: 3678859147 Enrollment ID: I20170418000635 |
| Provider Name | Brittany Kaye Gardiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912427139 PECOS PAC ID: 7719256387 Enrollment ID: I20170713001535 |
| Provider Name | Jennifer N Griswold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275971483 PECOS PAC ID: 0941560791 Enrollment ID: I20180321002516 |
| Provider Name | Aubrey Ann Kruisman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922593722 PECOS PAC ID: 3971853532 Enrollment ID: I20180904000482 |
| Provider Name | Sheri Lynn Schlagel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225437221 PECOS PAC ID: 3577783182 Enrollment ID: I20181107000683 |
| Provider Name | Melanie Elise Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518583988 PECOS PAC ID: 9537588488 Enrollment ID: I20200928000982 |
| Provider Name | Miriel Hope Collins Pittman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790458933 PECOS PAC ID: 2365849510 Enrollment ID: I20210930001659 |
| Provider Name | Katie Lynn Donnelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023781259 PECOS PAC ID: 3072908003 Enrollment ID: I20220309002751 |
| Provider Name | Jun Lin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053065847 PECOS PAC ID: 0042692964 Enrollment ID: I20220809000871 |
| Provider Name | Mark Duwayne Deis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821752676 PECOS PAC ID: 5799968483 Enrollment ID: I20221207002912 |
| Provider Name | Paige Christiana Erickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871167700 PECOS PAC ID: 3577933027 Enrollment ID: I20221228001509 |
| Provider Name | Angela Sue Bishop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205580495 PECOS PAC ID: 1254792013 Enrollment ID: I20230727000432 |
| Provider Name | Elisha Dawn Keene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629763214 PECOS PAC ID: 2365804143 Enrollment ID: I20230810001158 |
| Provider Name | Leisa Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902022502 PECOS PAC ID: 6507961620 Enrollment ID: I20231009000722 |
| Provider Name | Noelle Mortensen Haines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285214205 PECOS PAC ID: 9234586637 Enrollment ID: I20231107001104 |
| Provider Name | Candice Emma Dingman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790465581 PECOS PAC ID: 6406208339 Enrollment ID: I20240116004688 |
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