| Wasatch Geriatrics Pc | |
|
1414 E 4500 S #1 Salt Lake City UT 84117-4228 | |
| (801) 272-0255 | |
| (801) 947-0840 |
| Full Name | Wasatch Geriatrics Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1414 E 4500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Charles Steven Fehlauer (OWNER) |
| Authorized Official Contact | 8887006907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Geriatrics Pc Po Box 307 Bountiful UT 84011-0307 Ph: (801) 294-6907 | Wasatch Geriatrics Pc 1414 E 4500 S #1 Salt Lake City UT 84117-4228 Ph: (801) 272-0255 |
| NPI Number | 1619993276 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 01/28/2013 |
| Medicare PECOS PAC ID | 6002852589 |
|---|---|
| Medicare Enrollment ID | O20050706000877 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619993276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 294016-2401 (Utah) | Primary |
| Provider Name | Charles S Fehlauer |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1932285418 PECOS PAC ID: 1153344585 Enrollment ID: I20060111000586 |
| Provider Name | Debbie Quick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457570095 PECOS PAC ID: 4688834443 Enrollment ID: I20120402000415 |
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