| Enterprise Valley Medical Clinic, Inc. | |
|
223 South 200 East Enterprise UT 84725-0370 | |
| (435) 878-2281 | |
| (435) 878-2434 |
| Full Name | Enterprise Valley Medical Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 223 South 200 East, Enterprise, Utah |
| Authorized Official Name and Position | C.j. Hansen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4358782281 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enterprise Valley Medical Clinic, Inc. Po Box 370 Enterprise UT 84725-0370 Ph: (435) 878-2281 | Enterprise Valley Medical Clinic, Inc. 223 South 200 East Enterprise UT 84725-0370 Ph: (435) 878-2281 |
| NPI Number | 1659457786 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6709975436 |
|---|---|
| Medicare Enrollment ID | O20071204000392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659457786 | NPI | - | NPPES |
| 05883 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Thomas H Bigham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689642332 PECOS PAC ID: 6204826902 Enrollment ID: I20040514000659 |
Main Street Family Medicine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 571 East Main Street, Enterprise, UT 84725 Phone: 435-878-5711 |