| Hidden Valley Family Medicine Inc | |
|
12176 S 1000 E Draper UT 84020-9716 | |
| (801) 572-3750 | |
| (801) 572-1097 |
| Full Name | Hidden Valley Family Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 12176 S 1000 E, Draper, Utah |
| Authorized Official Name and Position | Benjamin Gunn (OFFICE MANAGER) |
| Authorized Official Contact | 8015723750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hidden Valley Family Medicine Inc Po Box 150610 Ogden UT 84415-0610 Ph: (801) 476-9200 | Hidden Valley Family Medicine Inc 12176 S 1000 E Draper UT 84020-9716 Ph: (801) 572-3750 |
| NPI Number | 1144246984 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 12/10/2007 |
| Medicare PECOS PAC ID | 5294899456 |
|---|---|
| Medicare Enrollment ID | O20090203000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144246984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 181268-1205 (Utah) | Secondary |
| 207Q00000X | Family Medicine | 181191-8905 (Utah) | Secondary |
| 207Q00000X | Family Medicine | 188509-1205 (Utah) | Primary |
| Provider Name | Carlie J Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104978873 PECOS PAC ID: 8729012893 Enrollment ID: I20050920000084 |
| Provider Name | Spencer J Hardenbrook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881952315 PECOS PAC ID: 5092968685 Enrollment ID: I20150609002795 |
| Provider Name | Rebecca Ann Waite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902333065 PECOS PAC ID: 8921364712 Enrollment ID: I20171110001522 |
| Provider Name | Mindy Marie Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760036024 PECOS PAC ID: 4082944590 Enrollment ID: I20190926001286 |
| Provider Name | Paula G Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205867553 PECOS PAC ID: 0345238952 Enrollment ID: I20201222000559 |
My Family Doctor Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 877 E 12300 S, Suite 201, Draper, UT 84020 Phone: 801-542-7111 Fax: 801-542-7112 | |
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