| Ogden Internal Medicine & Urology Llc | |
|
5405 S 500 E Ste 203 Ogden UT 84405-7417 | |
| (801) 475-8600 | |
| (801) 475-8686 |
| Full Name | Ogden Internal Medicine & Urology Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5405 S 500 E Ste 203, 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 |
|---|---|
| Ogden Internal Medicine & Urology Llc 2000 Health Park Dr Brentwood TN 37027-4525 Ph: (615) 373-7600 | Ogden Internal Medicine & Urology Llc 5405 S 500 E Ste 203 Ogden UT 84405-7417 Ph: (801) 475-8600 |
| NPI Number | 1003001553 |
|---|---|
| Provider Enumeration Date | 09/07/2007 |
| Last Update Date | 01/02/2023 |
| Medicare PECOS PAC ID | 2860575206 |
|---|---|
| Medicare Enrollment ID | O20080208000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003001553 | NPI | - | NPPES |
| 1003001553 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208800000X | Urology | (* (Not Available)) | Secondary |
| Provider Name | John K Reis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588689095 PECOS PAC ID: 2264330760 Enrollment ID: I20051109001247 |
| Provider Name | Richard J Herold |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891799318 PECOS PAC ID: 9133134448 Enrollment ID: I20060208000113 |
| Provider Name | Lea Marie Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730802950 PECOS PAC ID: 7810368768 Enrollment ID: I20230201000318 |
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