| Brian Eugene Elledge, DO | |
|
1000 E 100 N, Payson, UT 84651-1600 | |
| (801) 465-7041 | |
| (801) 465-7409 |
| Full Name | Brian Eugene Elledge |
|---|---|
| Gender | Male |
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1000 E 100 N, Payson, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174865455 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 20A14904 (California) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 9848744-1204 (Utah) | Primary |
| Entity Name | Mission City Community Network, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710102009 PECOS PAC ID: 1658264684 Enrollment ID: O20040204000544 |
| Entity Name | Jun R. Chiong, Md, Mph, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093099046 PECOS PAC ID: 5597925974 Enrollment ID: O20120321000723 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Eugene Elledge, DO Po Box 742353, Atlanta, GA 30374-2353 Ph: (310) 482-8403 | Brian Eugene Elledge, DO 1000 E 100 N, Payson, UT 84651-1600 Ph: (801) 465-7041 |
Dr. Kevin Lee, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1000 E 100 N, Payson, UT 84651 Phone: 801-465-7041 | |
Dr. Forrest Bodily, MD Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1000 E 100 N, Payson, UT 84651 Phone: 801-465-7041 Fax: 801-465-7409 | |
Dr. Lyle Milton Kinikini, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 97 Professional Way, Payson, UT 84651 Phone: 801-429-8000 | |
Scott David Daniels, MD, MHA Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1000 E 100 N, Payson, UT 84651 Phone: 801-465-7041 |