| Dr Gregory L Staker, MD | |
|
210 W 300 N 75-3, Roosevelt, UT 84066 | |
| (435) 722-3971 | |
| (435) 722-6104 |
| Full Name | Dr Gregory L Staker |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 29 Years |
| Location | 210 W 300 N 75-3, Roosevelt, Utah |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275593717 | NPI | - | NPPES |
| 000006166 | Other | UT | MEDICARE GROUP PIN |
| D3854 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 49110821205 (Utah) | Secondary |
| 208000000X | Pediatrics | 49110821205 (Utah) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Uintah Basin Medical Center | Roosevelt, UT | Hospital |
| Utah Valley Hospital | Provo, UT | Hospital |
| Ashley Regional Medical Center | Vernal, UT | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Uintah Basin Medical Center | 0244131944 | 61 |
| Northeastern Utah Medical Group | 2961496609 | 54 |
| Entity Name | Uintah Basin Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871556217 PECOS PAC ID: 0244131944 Enrollment ID: O20040226000948 |
| Entity Name | Northeastern Utah Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982664199 PECOS PAC ID: 2961496609 Enrollment ID: O20040414000471 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Gregory L Staker, MD 210 W 300 N 75-3, Roosevelt, UT 84066 Ph: (435) 722-3971 | Dr Gregory L Staker, MD 210 W 300 N 75-3, Roosevelt, UT 84066 Ph: (435) 722-3971 |
Dr. Shannon R Staker, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 210 W 300 N 75-3, Roosevelt, UT 84066 Phone: 435-722-3971 Fax: 435-722-6104 | |
Kyler Black, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-722-4691 | |
Dr. Jason S Beales, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 210 W 300 N 75-3, Roosevelt, UT 84066 Phone: 435-722-3971 Fax: 435-722-6104 |