| David Devenport, MD | |
|
672 W. 400 S., Suite 101, Springville, UT 84663 | |
| (801) 491-9883 | |
| (801) 489-3141 |
| Full Name | David Devenport |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 672 W. 400 S., Springville, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245258425 | NPI | - | NPPES |
| D3263 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 290516-1205 (Utah) | Primary |
| Entity Name | Central Utah Clinic Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093764805 PECOS PAC ID: 7517868508 Enrollment ID: O20040113000805 |
| Entity Name | Hobble Creek Medical Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013240845 PECOS PAC ID: 7911048251 Enrollment ID: O20100108000077 |
| Mailing Address | Practice Location Address |
|---|---|
| David Devenport, MD 1055 N 500 W, Attn Credentialing, Provo, UT 84604 Ph: (801) 354-8225 | David Devenport, MD 672 W. 400 S., Suite 101, Springville, UT 84663 Ph: (801) 491-9883 |
George H Michalek, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 672 W. 400 S., Suite 101, Springville, UT 84663 Phone: 801-491-9883 Fax: 801-489-3141 | |
Dr. Mark Jonathan Devenport, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 672 W. 400 S., Suite 101, Springville, UT 84663 Phone: 801-491-9883 Fax: 801-489-3141 | |
Dr. Stacey Townsend, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 672 W 400 S Ste 101, Springville, UT 84663 Phone: 801-491-9883 Fax: 801-489-3141 |