| Michael Mortensen, | |
|
862 S Main St Ste 4, Brigham City, UT 84302-3389 | |
| (435) 723-1799 | |
| Not Available |
| Full Name | Michael Mortensen |
|---|---|
| Gender | Male |
| Speciality | Counselor |
| Location | 862 S Main St Ste 4, Brigham City, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992103402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Entity Name | Southwest Utah Community Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659358687 PECOS PAC ID: 5799692398 Enrollment ID: O20050412000991 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Mortensen, 862 S Main St Ste 4, Brigham City, UT 84302-3389 Ph: () - | Michael Mortensen, 862 S Main St Ste 4, Brigham City, UT 84302-3389 Ph: (435) 723-1799 |
Matthew Lamar Huff, Counselor Medicare: Not Enrolled in Medicare Practice Location: 82 S 800 W, Brigham City, UT 84302 Phone: 435-723-8548 Fax: 435-538-5066 | |
Shanua Buck, Counselor Medicare: Not Enrolled in Medicare Practice Location: 82 S 800 W, Brigham City, UT 84302 Phone: 435-723-8548 | |
Alexandra Rosales, Counselor Medicare: Not Enrolled in Medicare Practice Location: 971 S 800 W, Brigham City, UT 84302 Phone: 435-239-8445 | |
Tein Daniel Hawke, Counselor Medicare: Not Enrolled in Medicare Practice Location: 862 S Main Suite 4, Brigham City, UT 84302 Phone: 435-723-1799 | |
Jesus Franco, Counselor Medicare: Not Enrolled in Medicare Practice Location: 82 S 800 W, Brigham City, UT 84302 Phone: 435-723-8548 | |
Esmeralda Gil, Counselor Medicare: Not Enrolled in Medicare Practice Location: 971 S 800 W, Brigham City, UT 84302 Phone: 435-239-8445 | |
Hyomin Son, Counselor Medicare: Not Enrolled in Medicare Practice Location: 971 S 800 W, Brigham City, UT 84302 Phone: 435-239-8445 |