| Gammawest Brachytherapy, Llc | |
|
1250 E 3900 S # B-10 Salt Lake City UT 84124-1348 | |
| (801) 456-8401 | |
| (801) 456-8408 |
| Full Name | Gammawest Brachytherapy, Llc |
|---|---|
| Speciality | Radiology |
| Location | 1250 E 3900 S # B-10, Salt Lake City, Utah |
| Authorized Official Name and Position | Robbie Rhymer (EVP HR & COO) |
| Authorized Official Contact | 1564677415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gammawest Brachytherapy, Llc 104 Woodmont Blvd Ste 500 Nashville TN 37205-2245 Ph: (615) 783-1254 | Gammawest Brachytherapy, Llc 1250 E 3900 S # B-10 Salt Lake City UT 84124-1348 Ph: (801) 456-8401 |
| NPI Number | 1053451617 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 09/12/2023 |
| Medicare PECOS PAC ID | 6800785510 |
|---|---|
| Medicare Enrollment ID | O20040311000967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053451617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 2085R0001X | Radiology - Radiation Oncology | 2054905-0160 (Utah) | Primary |
| Provider Name | Robert Alan Harris |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1144369752 PECOS PAC ID: 9830088038 Enrollment ID: I20040315000674 |
| Provider Name | John Keith Hayes |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1275672933 PECOS PAC ID: 3072402254 Enrollment ID: I20050226000094 |
| Provider Name | Charles Rogers |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1609915289 PECOS PAC ID: 4981649266 Enrollment ID: I20050627001241 |
| Provider Name | James W Clarke |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1295959724 PECOS PAC ID: 0648324749 Enrollment ID: I20090824000292 |
| Provider Name | Brandon J Fisher |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1275789026 PECOS PAC ID: 3779731708 Enrollment ID: I20120918000202 |
| Provider Name | Thomas B Skidmore |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1194905752 PECOS PAC ID: 3476701400 Enrollment ID: I20120918000220 |
| Provider Name | Chase C Hansen |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1265987945 PECOS PAC ID: 8527460914 Enrollment ID: I20210707003269 |
| Provider Name | Douglas E Holt |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1417310046 PECOS PAC ID: 3072914084 Enrollment ID: I20210820002684 |
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