| Treehouse Pediatrics & Family Care | |
|
1325 N 600 E Ste 101 Logan UT 84341-6743 | |
| (435) 213-3970 | |
| (435) 355-3746 |
| Full Name | Treehouse Pediatrics & Family Care |
|---|---|
| Speciality | Pediatrics |
| Location | 1325 N 600 E Ste 101, Logan, Utah |
| Authorized Official Name and Position | Miranda Overy Bryan (PRACTICE MANAGER) |
| Authorized Official Contact | 4357999101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Treehouse Pediatrics & Family Care 1325 N 600 E Ste 101 Logan UT 84341-6743 Ph: (435) 213-3970 | Treehouse Pediatrics & Family Care 1325 N 600 E Ste 101 Logan UT 84341-6743 Ph: (435) 213-3970 |
| NPI Number | 1619553864 |
|---|---|
| Provider Enumeration Date | 03/18/2021 |
| Last Update Date | 11/16/2022 |
| Medicare PECOS PAC ID | 7315343738 |
|---|---|
| Medicare Enrollment ID | O20210910001265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619553864 | NPI | - | NPPES |
| 528112320001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Bruce Alan O Very |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1225047996 PECOS PAC ID: 8022901362 Enrollment ID: I20040203000803 |
| Provider Name | Emily Fonua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184297129 PECOS PAC ID: 4981084399 Enrollment ID: I20220701001021 |
| Provider Name | Sarah Hope Horton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043085012 PECOS PAC ID: 3274985551 Enrollment ID: I20240123001598 |
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