| Centric Physicians Intermountain Region, Pllc | |
|
7101 N Mesa Street #365 Salt Lake City UT 84101-1603 | |
| (830) 267-4575 | |
| (830) 267-4575 |
| Full Name | Centric Physicians Intermountain Region, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 7101 N Mesa Street #365, Salt Lake City, Utah |
| Authorized Official Name and Position | Laura E. Givens (CEO) |
| Authorized Official Contact | 8302674575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centric Physicians Intermountain Region, Pllc 113 Pleasant Valley Dr Ste 210 Boerne TX 78006-5683 Ph: (830) 267-4575 | Centric Physicians Intermountain Region, Pllc 7101 N Mesa Street #365 Salt Lake City UT 84101-1603 Ph: (830) 267-4575 |
| NPI Number | 1467097071 |
|---|---|
| Provider Enumeration Date | 11/07/2019 |
| Last Update Date | 04/03/2020 |
| Medicare PECOS PAC ID | 2466880851 |
|---|---|
| Medicare Enrollment ID | O20200318001146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467097071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Laura Givens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902957046 PECOS PAC ID: 0345290847 Enrollment ID: I20200318001213 |
| Provider Name | Jesus Aranda-cano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003106543 PECOS PAC ID: 5496932469 Enrollment ID: I20200825002076 |
| Provider Name | Milton Shaw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346203007 PECOS PAC ID: 3678535879 Enrollment ID: I20210504002605 |
| Provider Name | Madisen Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689155764 PECOS PAC ID: 0547508525 Enrollment ID: I20221216002659 |
| Provider Name | Lucas Andrew Haws |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841905304 PECOS PAC ID: 7911370416 Enrollment ID: I20230303000932 |
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