| San Juan Clinic | |
|
380 W 100 N Suite A Monticello UT 84535-1054 | |
| (435) 587-5054 | |
| (435) 587-3004 |
| Full Name | San Juan Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 380 W 100 N, Monticello, Utah |
| Authorized Official Name and Position | Clayton Holt (CFO) |
| Authorized Official Contact | 4355871112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Clinic Po Box 1054 Monticello UT 84535-1054 Ph: (435) 587-5054 | San Juan Clinic 380 W 100 N Suite A Monticello UT 84535-1054 Ph: (435) 587-5054 |
| NPI Number | 1659315877 |
|---|---|
| Provider Enumeration Date | 06/16/2006 |
| Last Update Date | 07/17/2024 |
| Medicare PECOS PAC ID | 4486541851 |
|---|---|
| Medicare Enrollment ID | O20040301000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659315877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2005-HOSP-203 (Utah) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | 2011-HOSP-203 (Utah) | Primary |
| Provider Name | Glenn L. Robertson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144281122 PECOS PAC ID: 3870517618 Enrollment ID: I20060119000899 |
| Provider Name | Edwin M Wyman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730171620 PECOS PAC ID: 8628966512 Enrollment ID: I20100503000779 |
| Provider Name | Matthew H Lyman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1851307706 PECOS PAC ID: 4688747736 Enrollment ID: I20100916001218 |
| Provider Name | Kelly Jeppesen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568790558 PECOS PAC ID: 6608060876 Enrollment ID: I20101101001549 |
| Provider Name | Daniel J Roush |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1851577118 PECOS PAC ID: 5294813556 Enrollment ID: I20120314000213 |
| Provider Name | Zachary L Reese |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1871735340 PECOS PAC ID: 4082846084 Enrollment ID: I20150505001211 |
| Provider Name | Douglas Zeb Crofts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588924658 PECOS PAC ID: 8224351200 Enrollment ID: I20150910000176 |
| Provider Name | Nirmal Teja Sunkara |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1396908141 PECOS PAC ID: 4486823911 Enrollment ID: I20151112000638 |
| Provider Name | Michael Nielson |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1700225679 PECOS PAC ID: 2264735455 Enrollment ID: I20160622000080 |
| Provider Name | Jane Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285043885 PECOS PAC ID: 1254636939 Enrollment ID: I20161130002094 |
| Provider Name | Nicholas L Hugentobler |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508096116 PECOS PAC ID: 1658527361 Enrollment ID: I20170110001580 |
| Provider Name | Stephanie D Henderson |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1982997284 PECOS PAC ID: 5991074940 Enrollment ID: I20170706001586 |
| Provider Name | Mario D La Giglia |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013145697 PECOS PAC ID: 2860782927 Enrollment ID: I20180412001498 |
| Provider Name | Jeanne M Wigant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942736087 PECOS PAC ID: 7517202096 Enrollment ID: I20190103000725 |
| Provider Name | Jason D Doel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811424815 PECOS PAC ID: 0143573782 Enrollment ID: I20200731001679 |
| Provider Name | Stetler L Shumway |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1902474893 PECOS PAC ID: 3870997232 Enrollment ID: I20210806000646 |
| Provider Name | Francesca R Nichols |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649714577 PECOS PAC ID: 5092077685 Enrollment ID: I20220315002610 |
| Provider Name | Kade S Lyman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1003270059 PECOS PAC ID: 0749683423 Enrollment ID: I20220831002679 |
| Provider Name | Kristopher Hiatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962134759 PECOS PAC ID: 8628453362 Enrollment ID: I20220916002161 |
| Provider Name | Erik Johnston Rupard |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1437211299 PECOS PAC ID: 5496937484 Enrollment ID: I20230516003357 |
| Provider Name | Cory R Baum |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1821664582 PECOS PAC ID: 8729460258 Enrollment ID: I20230613003331 |
Imed Utah Heart - Monticello Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 380 W 100 N, Monticello, UT 84535 Phone: 801-507-3500 | |
San Juan Health Services District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 380 West 100 North, Monticello, UT 84535 Phone: 435-587-2116 Fax: 435-587-2061 |