| Ashley Valley Family Practice | |
|
872 W Highway 40 Vernal UT 84078-2416 | |
| (435) 781-8899 | |
| (435) 781-8898 |
| Full Name | Ashley Valley Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 872 W Highway 40, Vernal, Utah |
| Authorized Official Name and Position | Shaun C Shurtliff (PRESIDENT) |
| Authorized Official Contact | 4357818899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ashley Valley Family Practice 872 W Highway 40 Vernal UT 84078-2416 Ph: (435) 781-8899 | Ashley Valley Family Practice 872 W Highway 40 Vernal UT 84078-2416 Ph: (435) 781-8899 |
| NPI Number | 1881779809 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 10/28/2020 |
| Medicare PECOS PAC ID | 6406881747 |
|---|---|
| Medicare Enrollment ID | O20051005000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881779809 | NPI | - | NPPES |
| 07/16/1967 | Other | OWNER'S BIRTHDATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shaun C Shurtliff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285719294 PECOS PAC ID: 0941108096 Enrollment ID: I20031227000010 |
| Provider Name | Christina Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699225730 PECOS PAC ID: 3476832262 Enrollment ID: I20161118000870 |
| Provider Name | Ashley L Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497402887 PECOS PAC ID: 6204081896 Enrollment ID: I20221027002329 |
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