| Mountainstar Medical Group-st. Marks Hospital, Llc | |
|
348 E 4500 S Ste 300 Salt Lake City UT 84107-8535 | |
| (801) 266-2777 | |
| Not Available |
| Full Name | Mountainstar Medical Group-st. Marks Hospital, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 348 E 4500 S Ste 300, Salt Lake City, 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-st. Marks Hospital, Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7600 | Mountainstar Medical Group-st. Marks Hospital, Llc 348 E 4500 S Ste 300 Salt Lake City UT 84107-8535 Ph: (801) 266-2777 |
| NPI Number | 1073795258 |
|---|---|
| Provider Enumeration Date | 11/29/2007 |
| Last Update Date | 01/02/2023 |
| Medicare PECOS PAC ID | 1557443322 |
|---|---|
| Medicare Enrollment ID | O20080201000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073795258 | NPI | - | NPPES |
| 1073795258 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kevin W Tschetter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912922923 PECOS PAC ID: 2062313059 Enrollment ID: I20040113000806 |
| Provider Name | Philip Leonard Roberts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013012418 PECOS PAC ID: 6608777693 Enrollment ID: I20040114000625 |
| Provider Name | David E Curtis |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730222720 PECOS PAC ID: 0648160515 Enrollment ID: I20040603001438 |
| Provider Name | Amelia Maass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366488348 PECOS PAC ID: 1355367244 Enrollment ID: I20051020000214 |
| Provider Name | Leeann Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942462825 PECOS PAC ID: 5294896262 Enrollment ID: I20081209000489 |
| Provider Name | Joni W Hougaard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508801606 PECOS PAC ID: 8426110016 Enrollment ID: I20081216000119 |
| Provider Name | Cynthia Canga Siao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669497558 PECOS PAC ID: 2163564774 Enrollment ID: I20100120000558 |
| Provider Name | Todd W. Furness |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285941310 PECOS PAC ID: 5496999039 Enrollment ID: I20130920000205 |
| Provider Name | Joanna L Tierney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801996384 PECOS PAC ID: 8325034630 Enrollment ID: I20131231001516 |
| Provider Name | Andrew Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366782567 PECOS PAC ID: 3072835271 Enrollment ID: I20141125000384 |
| Provider Name | Preston Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952538605 PECOS PAC ID: 9234353954 Enrollment ID: I20160421001376 |
| Provider Name | Daniel Trevor Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114301710 PECOS PAC ID: 1759621089 Enrollment ID: I20190322000667 |
| Provider Name | Betsy L Reese |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477817443 PECOS PAC ID: 8426396938 Enrollment ID: I20190626001322 |
| Provider Name | Bradley M Watts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043741929 PECOS PAC ID: 8224453667 Enrollment ID: I20200803001363 |
| Provider Name | Tracy Lynn Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124607940 PECOS PAC ID: 3577955889 Enrollment ID: I20220119000463 |
| Provider Name | Andrew S Pettit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487200853 PECOS PAC ID: 1254767247 Enrollment ID: I20230203001923 |
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