| Mindful Mobile Medicine LLC | |
|
623 E Fort Union Blvd Ste 105 Midvale UT 84047-5529 | |
| (801) 879-2664 | |
| Not Available |
| Full Name | Mindful Mobile Medicine LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 623 E Fort Union Blvd Ste 105, Midvale, Utah |
| Authorized Official Name and Position | Tyler Young (VP) |
| Authorized Official Contact | 8018792664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Mobile Medicine LLC 623 E Fort Union Blvd Ste 105 Midvale UT 84047-5529 Ph: (385) 412-1660 | Mindful Mobile Medicine LLC 623 E Fort Union Blvd Ste 105 Midvale UT 84047-5529 Ph: (801) 879-2664 |
| NPI Number | 1245068626 |
|---|---|
| Provider Enumeration Date | 07/25/2024 |
| Last Update Date | 02/10/2025 |
| Certification Date | 02/10/2025 |
| Medicare PECOS PAC ID | 1254865363 |
|---|---|
| Medicare Enrollment ID | O20241112004201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245068626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| 363LG0600X | Nurse Practitioner - Gerontology | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Secondary |
| Provider Name | Carley a Florence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235990565 PECOS PAC ID: 1850737818 Enrollment ID: I20240312004212 |
| Provider Name | Tonya Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053162263 PECOS PAC ID: 7416397732 Enrollment ID: I20240502002697 |
| Provider Name | Caitlin Randi Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376421883 PECOS PAC ID: 4486143583 Enrollment ID: I20251029002455 |
| Provider Name | Tara Agee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366315541 PECOS PAC ID: 5890277503 Enrollment ID: I20260303002410 |
| Provider Name | Jaime M Tracy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548528896 PECOS PAC ID: 1850868985 Enrollment ID: I20260427001948 |
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