| Living Tree Medical Group | |
|
1635 N 200 E Logan UT 84341-1913 | |
| (435) 565-6043 | |
| (435) 215-4420 |
| Full Name | Living Tree Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1635 N 200 E, Logan, Utah |
| Authorized Official Name and Position | Kris Coleman (COC) |
| Authorized Official Contact | 4357702131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Tree Medical Group 1635 N 200 E Logan UT 84341-1913 Ph: (435) 565-6043 | Living Tree Medical Group 1635 N 200 E Logan UT 84341-1913 Ph: (435) 565-6043 |
| NPI Number | 1639754583 |
|---|---|
| Provider Enumeration Date | 03/12/2021 |
| Last Update Date | 07/11/2025 |
| Medicare PECOS PAC ID | 5294128963 |
|---|---|
| Medicare Enrollment ID | O20220202001670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639754583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Gordon S Wood |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1255328969 PECOS PAC ID: 1052334588 Enrollment ID: I20060110000898 |
| Provider Name | Matthew J Welter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164486064 PECOS PAC ID: 3274426374 Enrollment ID: I20060113000864 |
| Provider Name | Kevin R Duke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003882713 PECOS PAC ID: 8820028673 Enrollment ID: I20111219000058 |
| Provider Name | John David Malouf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992097612 PECOS PAC ID: 3779700042 Enrollment ID: I20160601000164 |
| Provider Name | Jennifer Carter Mosteller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801356530 PECOS PAC ID: 7810230158 Enrollment ID: I20190530000079 |
| Provider Name | Savannah Alder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811519085 PECOS PAC ID: 2567882665 Enrollment ID: I20201012000590 |
| Provider Name | Justen Gregory Watkins |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689090060 PECOS PAC ID: 0941584254 Enrollment ID: I20240513001894 |
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Affinity Healthcare, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 93 East 200 South, Suite 210-b, Logan, UT 84321 Phone: 435-276-0888 Fax: 833-471-4536 |