| Seth M Grisham, PA-C | |
|
555 W State Road 164, Salem, UT 84653-5732 | |
| (801) 465-4896 | |
| Not Available |
| Full Name | Seth M Grisham |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Medical |
| Location | 555 W State Road 164, Salem, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710402540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Primary |
| Entity Name | Revere Health PC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093764805 PECOS PAC ID: 7517868508 Enrollment ID: O20040113000805 |
| Mailing Address | Practice Location Address |
|---|---|
| Seth M Grisham, PA-C 1055 N 500 W, Attn Credentialing, Provo, UT 84604-3305 Ph: (801) 354-8225 | Seth M Grisham, PA-C 555 W State Road 164, Salem, UT 84653-5732 Ph: (801) 465-4896 |
Robert Wright, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 801-465-4896 |
Shawn Stephen Hill, MPAS Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 801-465-4813 Fax: 801-812-5433 |
Jason Eatough, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W State Road 164, Salem, UT 84653 Phone: 801-465-4896 Fax: 801-465-0606 |
Nathan Sanborn, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 801-465-4896 Fax: 801-465-3267 |
Jonathan D Nelson, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 801-465-4813 Fax: 801-812-5433 |
James Vance Dodds, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 555 W State Road 164, Salem, UT 84653 Phone: 385-265-6050 Fax: 801-465-3267 |
Whitney Mccoy, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 555 W Sr 164, Salem, UT 84653 Phone: 801-465-4896 Fax: 801-465-3267 |