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250 W 300 N Roosevelt UT 84066-2336 | |
(435) 725-7448 | |
(435) 722-9291 |
Full Name | |
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Speciality | Clinic/Center |
Location | 250 W 300 N, Roosevelt, 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) 725-7448 | 250 W 300 N Roosevelt UT 84066-2336 Ph: (435) 725-7448 |
NPI Number | 1851920151 |
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Provider Enumeration Date | 04/07/2020 |
Last Update Date | 02/15/2024 |
Medicare PECOS PAC ID | 0244131944 |
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Medicare Enrollment ID | O20200519000819 |
Identifier | Type | State | Issuer |
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1851920151 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |