Full Name | |
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Speciality | Clinic/Center |
Location | 50 S 200 E, Duchesne, Utah |
Authorized Official Name and Position | James Marshall (CEO) |
Authorized Official Contact | 4357257448 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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250 W 300 N Roosevelt UT 84066-2336 Ph: (435) 722-4691 | 50 S 200 E Duchesne UT 84021 Ph: (435) 738-2845 |
NPI Number | 1679193338 |
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Provider Enumeration Date | 04/23/2020 |
Last Update Date | 02/15/2024 |
Medicare PECOS PAC ID | 0244131944 |
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Medicare Enrollment ID | O20200520000624 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679193338 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |