Pine Top Medical P.c. | |
284 N Hospital Dr Suite 2 Price UT 84501-4233 | |
(435) 637-5690 | |
(435) 637-9809 |
Full Name | Pine Top Medical P.c. |
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Speciality | Clinic/Center |
Location | 284 N Hospital Dr, Price, Utah |
Authorized Official Name and Position | Eugene Douglas Larsen (PRESIDENT) |
Authorized Official Contact | 8013095156 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pine Top Medical P.c. 284 N Hospital Dr Suite 2 Price UT 84501-4233 Ph: (435) 637-5690 | Pine Top Medical P.c. 284 N Hospital Dr Suite 2 Price UT 84501-4233 Ph: (435) 637-5690 |
NPI Number | 1679956445 |
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Provider Enumeration Date | 06/29/2015 |
Last Update Date | 08/10/2015 |
Medicare PECOS PAC ID | 4183930241 |
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Medicare Enrollment ID | O20150903001703 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679956445 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 93369771204 (Utah) | Primary |
Provider Name | Eugene Douglas Larsen |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1447513221 PECOS PAC ID: 8527290923 Enrollment ID: I20150903001782 |
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