| Wasatch Rpm Llc | |
|
5825 Harrison Blvd Ogden UT 84403-4316 | |
| (801) 475-5254 | |
| (801) 797-0278 |
| Full Name | Wasatch Rpm Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 5825 Harrison Blvd, Ogden, Utah |
| Authorized Official Name and Position | Joseph Fyans (OWNER) |
| Authorized Official Contact | 8014755254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Rpm Llc 5825 Harrison Blvd Ogden UT 84403-4316 Ph: (801) 475-5254 | Wasatch Rpm Llc 5825 Harrison Blvd Ogden UT 84403-4316 Ph: (801) 475-5254 |
| NPI Number | 1053175976 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 06/07/2024 |
| Medicare PECOS PAC ID | 2163868829 |
|---|---|
| Medicare Enrollment ID | O20240315003262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053175976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Joseph C Fyans |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447431317 PECOS PAC ID: 8426125451 Enrollment ID: I20080917000448 |
| Provider Name | Cameron G Peterson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1164604765 PECOS PAC ID: 5991855207 Enrollment ID: I20090609000004 |
| Provider Name | James Barclay Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992080915 PECOS PAC ID: 9739355595 Enrollment ID: I20150818003529 |
| Provider Name | Cody J Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962088732 PECOS PAC ID: 3779897285 Enrollment ID: I20210621002257 |
| Provider Name | Mark Duwayne Deis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821752676 PECOS PAC ID: 5799968483 Enrollment ID: I20221207002912 |
| Provider Name | Jason Eversole |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699159178 PECOS PAC ID: 2365792330 Enrollment ID: I20240126001464 |
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