| Kaysville Clinic, Llc | |
|
934 S Main Layton UT 84041-4250 | |
| (801) 544-4227 | |
| (801) 544-3724 |
| Full Name | Kaysville Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 934 S Main, Layton, Utah |
| Authorized Official Name and Position | Layne K Kamalu (OWNER) |
| Authorized Official Contact | 8015444227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaysville Clinic, Llc 934 S Main Layton UT 84041-4250 Ph: (801) 544-4227 | Kaysville Clinic, Llc 934 S Main Layton UT 84041-4250 Ph: (801) 544-4227 |
| NPI Number | 1013047521 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 10/26/2007 |
| Medicare PECOS PAC ID | 2264331636 |
|---|---|
| Medicare Enrollment ID | O20040105000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013047521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Layne Keliiokalam Kamalu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104987916 PECOS PAC ID: 9335048701 Enrollment ID: I20051116000272 |
| Provider Name | Cara Mellor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932396280 PECOS PAC ID: 7810077948 Enrollment ID: I20080102000397 |
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