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382 W 280 N Providence UT 84332-9753 | |
(435) 752-0330 | |
(435) 755-0922 |
Full Name | |
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Speciality | Family Medicine |
Location | 382 W 280 N, Providence, Utah |
Authorized Official Name and Position | Louis Joseph (VP) |
Authorized Official Contact | 6153737630 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7600 | 382 W 280 N Providence UT 84332-9753 Ph: (435) 752-0330 |
NPI Number | 1144475674 |
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Provider Enumeration Date | 11/25/2008 |
Last Update Date | 01/02/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144475674 | NPI | - | NPPES |
1144475674 | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Living Tree Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 169 N Gateway Dr Ste 170, Providence, UT 84332 Phone: 435-565-6043 Fax: 435-215-4420 | |
Peachtree Family Medicine Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 565 W 465 N Ste 130, Providence, UT 84332 Phone: 435-752-5553 Fax: 435-755-5043 | |