| Sentry Medical | |
|
258 S Main St Ste 210 Logan UT 84321-5768 | |
| (435) 383-6120 | |
| (435) 557-8003 |
| Full Name | Sentry Medical |
|---|---|
| Speciality | Internal Medicine |
| Location | 258 S Main St Ste 210, Logan, Utah |
| Authorized Official Name and Position | Gregory Chad Mangum (OWNER) |
| Authorized Official Contact | 4353836120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sentry Medical Po Box 86 Providence UT 84332-0086 Ph: (435) 383-6120 | Sentry Medical 258 S Main St Ste 210 Logan UT 84321-5768 Ph: (435) 383-6120 |
| NPI Number | 1568928133 |
|---|---|
| Provider Enumeration Date | 02/19/2019 |
| Last Update Date | 09/26/2025 |
| Certification Date | 09/26/2025 |
| Medicare PECOS PAC ID | 4981937034 |
|---|---|
| Medicare Enrollment ID | O20190605001965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568928133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Ryan H Larsen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1235224932 PECOS PAC ID: 3971525064 Enrollment ID: I20060104000144 |
| Provider Name | Brett Cardon Porter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134175037 PECOS PAC ID: 8628975463 Enrollment ID: I20060110000303 |
| Provider Name | Nathan D Broschinsky |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467894998 PECOS PAC ID: 7719114537 Enrollment ID: I20131223001611 |
| Provider Name | Jacob Sanderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265094742 PECOS PAC ID: 3971834441 Enrollment ID: I20191015000287 |
| Provider Name | Carla Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588297360 PECOS PAC ID: 6901236868 Enrollment ID: I20200417001337 |
| Provider Name | Alexander Doxey |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295265528 PECOS PAC ID: 4688943426 Enrollment ID: I20200619001912 |
| Provider Name | Scott Nagao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205320991 PECOS PAC ID: 8123376639 Enrollment ID: I20210513001265 |
| Provider Name | Clark George Johnson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407124910 PECOS PAC ID: 9537545157 Enrollment ID: I20221005003383 |
| Provider Name | Miranda Paulsen Buttars |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144913344 PECOS PAC ID: 1153781695 Enrollment ID: I20230717000668 |
| Provider Name | Walker J Riley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669368742 PECOS PAC ID: 4880192178 Enrollment ID: I20250806004117 |
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