| Brian T Boden, PAC | |
|
1975 N State St, Orem, UT 84057-2028 | |
| (801) 714-5000 | |
| Not Available |
| Full Name | Brian T Boden |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 1975 N State St, Orem, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316938673 | NPI | - | NPPES |
| 200052790A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 1391 (Oklahoma) | Secondary |
| 363A00000X | Physician Assistant | 7060654-1206 (Utah) | Primary |
| Entity Name | Alaska Native Tribal Health Consortium |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437189339 PECOS PAC ID: 6709780265 Enrollment ID: O20031125000772 |
| Entity Name | Southcentral Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780614263 PECOS PAC ID: 5496663627 Enrollment ID: O20051027000416 |
| Mailing Address | Practice Location Address |
|---|---|
| Brian T Boden, PAC Po Box 27128, Salt Lake City, UT 84127-0128 Ph: (801) 714-5000 | Brian T Boden, PAC 1975 N State St, Orem, UT 84057-2028 Ph: (801) 714-5000 |
Mrs. Chelsea Genna Marshall, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 501 E 770 N, Orem, UT 84097 Phone: 801-724-9840 Fax: 801-235-1509 |
Allison Nicole Sipple, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 800 W University Pkwy, Orem, UT 84058 Phone: 801-671-5033 |
Joshua D Arnold, PAC Physician Assistant Medicare: Medicare Enrolled Practice Location: 501 E 770 N, Orem, UT 84097 Phone: 801-724-9840 Fax: 801-235-1509 |
Ashley Harward, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 173 N 400 W Ste C11, Orem, UT 84057 Phone: 801-802-7373 Fax: 801-802-7733 |
Scott West, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 552 W 800 N, Orem, UT 84057 Phone: 801-764-0200 Fax: 801-764-0206 |
Albert Pope, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 552 W 800 N, Orem, UT 84057 Phone: 801-764-0200 Fax: 801-764-0206 |
Matthew R Lovelace, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 173 N 400 W Ste C11, Orem, UT 84057 Phone: 801-802-7373 Fax: 801-802-7733 |