| Medallus Medical | |
|
1126 E 12300 S Draper UT 84020-9095 | |
| (801) 545-0600 | |
| (801) 545-0626 |
| Full Name | Medallus Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1126 E 12300 S, Draper, Utah |
| Authorized Official Name and Position | Monique S Aragon (COMPLIANCE ADMIN ASST/ CREDENTIALIN) |
| Authorized Official Contact | 8012601919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medallus Medical Po Box 95970 South Jordan UT 84095-0970 Ph: (801) 352-9500 | Medallus Medical 1126 E 12300 S Draper UT 84020-9095 Ph: (801) 545-0600 |
| NPI Number | 1437251279 |
|---|---|
| Provider Enumeration Date | 09/02/2006 |
| Last Update Date | 03/28/2024 |
| Medicare PECOS PAC ID | 8123926904 |
|---|---|
| Medicare Enrollment ID | O20031230000815 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437251279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Rachot K Vacharothone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548228497 PECOS PAC ID: 9931013745 Enrollment ID: I20031117000317 |
| Provider Name | Brad K Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871609222 PECOS PAC ID: 5193624930 Enrollment ID: I20031231000311 |
| Provider Name | Max G Morgan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285699264 PECOS PAC ID: 2365335486 Enrollment ID: I20040205000355 |
| Provider Name | Todd R Wilcox |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861428856 PECOS PAC ID: 8022078070 Enrollment ID: I20041013001255 |
| Provider Name | Carla Sue Foster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841237005 PECOS PAC ID: 9234195488 Enrollment ID: I20041208001168 |
| Provider Name | Lawrence B Grandy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306829056 PECOS PAC ID: 7416997101 Enrollment ID: I20050512000320 |
| Provider Name | Lisa M Anderson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083679989 PECOS PAC ID: 7618991456 Enrollment ID: I20060119000883 |
| Provider Name | Robert E Warrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164514071 PECOS PAC ID: 3678655610 Enrollment ID: I20081218000378 |
| Provider Name | Amy Larae Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871751297 PECOS PAC ID: 7810043817 Enrollment ID: I20090916000311 |
| Provider Name | Stephen Kirk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578737979 PECOS PAC ID: 3173661881 Enrollment ID: I20091117000154 |
| Provider Name | James S Mcintyre |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1043446602 PECOS PAC ID: 9739339524 Enrollment ID: I20130918000811 |
| Provider Name | Stephanie Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043520489 PECOS PAC ID: 4587819826 Enrollment ID: I20140228001861 |
| Provider Name | Carlos A Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215376587 PECOS PAC ID: 4082846795 Enrollment ID: I20140411001102 |
| Provider Name | Mark W Peterson |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1326374562 PECOS PAC ID: 8325291024 Enrollment ID: I20140523001019 |
| Provider Name | David Joshua Brockbank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710222310 PECOS PAC ID: 8123246865 Enrollment ID: I20140821002166 |
| Provider Name | Tina Margareta Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942480470 PECOS PAC ID: 9830116516 Enrollment ID: I20151105001580 |
| Provider Name | Roger Michael Moczygemba |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750382503 PECOS PAC ID: 2365427796 Enrollment ID: I20160429000397 |
| Provider Name | Arwen C York |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255881397 PECOS PAC ID: 3173801719 Enrollment ID: I20161101002654 |
| Provider Name | Gretchen A Dennison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801335005 PECOS PAC ID: 4981981198 Enrollment ID: I20170425002428 |
| Provider Name | Dallin L Demordaunt |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1336128388 PECOS PAC ID: 5890723142 Enrollment ID: I20170622001960 |
| Provider Name | Erika Seaquist-goble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558804641 PECOS PAC ID: 7012288673 Enrollment ID: I20170801001799 |
| Provider Name | Cynthia A Whiting |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508383175 PECOS PAC ID: 6507130770 Enrollment ID: I20170927001061 |
| Provider Name | Sariah P Machado-lovon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679095111 PECOS PAC ID: 8325314909 Enrollment ID: I20171026001060 |
| Provider Name | Brian James Larkin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205278355 PECOS PAC ID: 1557661493 Enrollment ID: I20171214003043 |
| Provider Name | Eric Scott Overton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225448327 PECOS PAC ID: 5092074773 Enrollment ID: I20180126000510 |
| Provider Name | Rynthia G Crosbie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235649674 PECOS PAC ID: 2668733064 Enrollment ID: I20181031000064 |
| Provider Name | Tawni M Aleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316426059 PECOS PAC ID: 9335484310 Enrollment ID: I20181219001722 |
| Provider Name | Julia Margarita Kammel |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1407210446 PECOS PAC ID: 9032485651 Enrollment ID: I20190603002332 |
| Provider Name | Wesley C Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841603941 PECOS PAC ID: 3173819380 Enrollment ID: I20200130000431 |
| Provider Name | Shannon Q Dunlop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750624672 PECOS PAC ID: 7315378346 Enrollment ID: I20200507001242 |
| Provider Name | Jennifer Melcomian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487119491 PECOS PAC ID: 5395158364 Enrollment ID: I20210112001232 |
| Provider Name | Brandi N Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720592017 PECOS PAC ID: 3678833944 Enrollment ID: I20220603001975 |
| Provider Name | Terracina Fischer Zitting |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225799869 PECOS PAC ID: 5799140935 Enrollment ID: I20230424000859 |
| Provider Name | Jennifer Christine Oleskowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053015735 PECOS PAC ID: 6608233093 Enrollment ID: I20230530002059 |
| Provider Name | Hailey B Yamashiro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881324044 PECOS PAC ID: 8325409634 Enrollment ID: I20230803000288 |
| Provider Name | Mckinsey Owen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932982998 PECOS PAC ID: 4880038017 Enrollment ID: I20240215003398 |
My Family Doctor Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 877 E 12300 S, Suite 201, Draper, UT 84020 Phone: 801-542-7111 Fax: 801-542-7112 | |
Spencer J Hardenbrook Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12176 S 1000 E, Draper, UT 84020 Phone: 800-640-3451 Fax: 801-572-1097 | |
Wasathc Health Solutions Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1135 Parkstone Dr, Draper, UT 84020 Phone: 801-641-3686 Fax: 801-545-8744 | |
Hidden Valley Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12176 S 1000 E, Draper, UT 84020 Phone: 801-572-3750 Fax: 801-572-1097 | |
Granger Medical Specialists Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 96 E Kimballs Ln Ste 304, Draper, UT 84020 Phone: 801-571-9433 | |
Lone Peak Medical Associates Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14768 S Dryburg Cv, Draper, UT 84020 Phone: 801-558-5126 Fax: 801-206-3823 | |
Landmark Medical Of Utah, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12921 S Vista Station Blvd, Draper, UT 84020 Phone: 657-400-5180 |