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627 W 4000 N Pleasant Grove UT 84062-8754 | |
| (801) 471-1965 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 627 W 4000 N, Pleasant Grove, Utah |
| Authorized Official Name and Position | Bret Jones (CEO) |
| Authorized Official Contact | 8014711965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
627 W 4000 N Pleasant Grove UT 84062-8754 Ph: (801) 471-1965 | 627 W 4000 N Pleasant Grove UT 84062-8754 Ph: (801) 471-1965 |
| NPI Number | 1497595011 |
|---|---|
| Provider Enumeration Date | 05/30/2024 |
| Last Update Date | 06/27/2024 |
| Medicare PECOS PAC ID | 1557807278 |
|---|---|
| Medicare Enrollment ID | O20240718000929 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497595011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Noelle Mortensen Haines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285214205 PECOS PAC ID: 9234586637 Enrollment ID: I20231107001104 |
| Provider Name | Chelsie Franque Harris |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1952136350 PECOS PAC ID: 1759814304 Enrollment ID: I20241104002950 |
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