| Mountainstar Medical Group-ogden Regional Medical Center, Llc | |
|
5405 S 500 E Ste. 100 Ogden UT 84405-6957 | |
| (801) 282-5952 | |
| (801) 569-5990 |
| Full Name | Mountainstar Medical Group-ogden Regional Medical Center, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5405 S 500 E, Ogden, 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 Medical Group-ogden Regional Medical Center, Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7406 | Mountainstar Medical Group-ogden Regional Medical Center, Llc 5405 S 500 E Ste. 100 Ogden UT 84405-6957 Ph: (801) 282-5952 |
| NPI Number | 1356588008 |
|---|---|
| Provider Enumeration Date | 01/17/2009 |
| Last Update Date | 08/29/2023 |
| Medicare PECOS PAC ID | 0840356184 |
|---|---|
| Medicare Enrollment ID | O20090311000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356588008 | NPI | - | NPPES |
| 1356588008 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Adam C Craner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952326357 PECOS PAC ID: 4789585159 Enrollment ID: I20040119000171 |
| Provider Name | Robert Mohr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750314480 PECOS PAC ID: 0648178145 Enrollment ID: I20050525000532 |
| Provider Name | Keith W Elkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679613475 PECOS PAC ID: 8224052808 Enrollment ID: I20171222000552 |
| Provider Name | Ramsey L Gosselin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083140479 PECOS PAC ID: 1153688429 Enrollment ID: I20191119001082 |
| Provider Name | Jamison Stan Rees |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982231312 PECOS PAC ID: 9133539240 Enrollment ID: I20201030002057 |
| Provider Name | Andrea Marie Bartholomew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609572221 PECOS PAC ID: 5799148862 Enrollment ID: I20230823001624 |
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