| Mountainstar Cache Valley Medical Group | |
|
382 W 280 N Providence UT 84332-9753 | |
| (435) 752-0330 | |
| (435) 755-0922 |
| Full Name | Mountainstar Cache Valley Medical Group |
|---|---|
| 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 | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountainstar Cache Valley Medical Group 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7600 | Mountainstar Cache Valley Medical Group 382 W 280 N Providence UT 84332-9753 Ph: (435) 752-0330 |
| NPI Number | 1144475674 |
|---|---|
| Provider Enumeration Date | 11/25/2008 |
| Last Update Date | 01/02/2023 |
| Medicare PECOS PAC ID | 5193887149 |
|---|---|
| Medicare Enrollment ID | O20081229000411 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144475674 | NPI | - | NPPES |
| 1144475674 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard Thomas Stevens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790739449 PECOS PAC ID: 6709889033 Enrollment ID: I20060807000142 |
| Provider Name | Mark Traveller Hansen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1689646507 PECOS PAC ID: 7911193990 Enrollment ID: I20101202000672 |
| Provider Name | James Dennis Mathews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518113216 PECOS PAC ID: 8729217310 Enrollment ID: I20140627000198 |
| Provider Name | Ryan W Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689089666 PECOS PAC ID: 3476771023 Enrollment ID: I20211227000799 |
| Provider Name | David Vere Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336601913 PECOS PAC ID: 7416377726 Enrollment ID: I20220816001425 |
Health West Providence Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 517 W 100 N Ste 110, Providence, UT 84332 Phone: 435-213-4225 | |
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 | |
Cache Valley Community Health Center - Providence Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 517 W 100 N Ste 110, Providence, UT 84332 Phone: 435-755-6075 Fax: 435-994-8362 | |
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 | |
Foot & Ankle Center Of Cache Valley Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 435 N Gateway Dr Ste 801, Providence, UT 84332 Phone: 435-787-1023 Fax: 435-787-1883 |