| Peachtree Family Medicine Pc | |
|
565 W 465 N Ste 130 Providence UT 84332-4802 | |
| (435) 752-5553 | |
| (435) 755-5043 |
| Full Name | Peachtree Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 565 W 465 N Ste 130, Providence, Utah |
| Authorized Official Name and Position | Vera B Carlson (MD) |
| Authorized Official Contact | 4357525553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peachtree Family Medicine Pc 169 N Gateway Dr 170 Providence UT 84332-9855 Ph: (435) 752-5553 | Peachtree Family Medicine Pc 565 W 465 N Ste 130 Providence UT 84332-4802 Ph: (435) 752-5553 |
| NPI Number | 1679608582 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 11/06/2024 |
| Medicare PECOS PAC ID | 0941221436 |
|---|---|
| Medicare Enrollment ID | O20051213000084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679608582 | NPI | - | NPPES |
| 225939539001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5916429-1205 (Utah) | Primary |
| Provider Name | Vera Carlson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023095585 PECOS PAC ID: 8921057803 Enrollment ID: I20051213000106 |
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