| Primary Healthcare, Pllc | |
|
6095 S Fashion Blvd Ste 220 Murray UT 84107-7393 | |
| (801) 758-8735 | |
| (801) 769-3991 |
| Full Name | Primary Healthcare, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6095 S Fashion Blvd Ste 220, Murray, Utah |
| Authorized Official Name and Position | Kevin Mangum (CEO/PHYSICIAN) |
| Authorized Official Contact | 8017588735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Healthcare, Pllc 6095 S Fashion Blvd Ste 220 Murray UT 84107-7393 Ph: (801) 758-8735 | Primary Healthcare, Pllc 6095 S Fashion Blvd Ste 220 Murray UT 84107-7393 Ph: (801) 758-8735 |
| NPI Number | 1700503182 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 06/02/2023 |
| Medicare PECOS PAC ID | 5092187617 |
|---|---|
| Medicare Enrollment ID | O20230208001581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700503182 | NPI | - | NPPES |
| Provider Name | Tiffany Pulgiano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538542840 PECOS PAC ID: 5395051494 Enrollment ID: I20150903003019 |
| Provider Name | Kevin Mangum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609140847 PECOS PAC ID: 2961825641 Enrollment ID: I20210813003052 |
| Provider Name | Whitney Corinne John |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780308833 PECOS PAC ID: 9739559477 Enrollment ID: I20221221001946 |
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