Advantage Medical Center Llc is a medicare enrolled "Family Medicine" provider in Brigham City, Utah. Their current practice location is
770 S 200 E, Ste 102, Brigham City, Utah. You can reach out to their office (for appointments etc.) via phone at
(435) 723-0517.
Advantage Medical Center Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Advantage Medical Center Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1053861567.
Healthcare Provider's Profile
| Full Name | Advantage Medical Center Llc |
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| Type | Facility |
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| Speciality | Family Medicine |
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| Location | 770 S 200 E, Brigham City, Utah |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1053861567
- Provider Enumeration Date: 10/07/2016
- Last Update Date: 12/01/2016
Medicare PECOS Information:
- PECOS PAC ID: 4981971207
- Enrollment ID: O20170517000340
Medical Identifiers
Medical identifiers for Advantage Medical Center Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1053861567 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | 5118842-0160 (Utah) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | 189510-4405 (Utah) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Advantage Medical Center Llc acts as a billing entity for following providers:
| Provider Name | Jeffrey R Lish |
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| Provider Type | Practitioner - Family Practice |
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| Provider Identifiers | NPI Number: 1003848797
PECOS PAC ID: 3375435357
Enrollment ID: I20040325001053 |
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| Provider Name | Cynthia Lynn Hazelwood |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1922242262
PECOS PAC ID: 2163578436
Enrollment ID: I20090929000311 |
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| Provider Name | Kirk Russell Waldron |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1215599105
PECOS PAC ID: 3274861968
Enrollment ID: I20190819003094 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Advantage Medical Center Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Advantage Medical Center Llc
770 S 200 E, Ste 102,
Brigham City, UT 84302
Ph: (435) 723-0517 | Advantage Medical Center Llc
770 S 200 E, Ste 102,
Brigham City, UT 84302
Ph: (435) 723-0517 |
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