| Mmg Stansbury Family Practice Llc | |
|
576 E Highway 138 Ste 310 Stansbury Pk UT 84074-4028 | |
| (801) 456-2333 | |
| (801) 456-2330 |
| Full Name | Mmg Stansbury Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 576 E Highway 138 Ste 310, Stansbury Pk, Utah |
| Authorized Official Name and Position | Cameron Cooper (OWNER) |
| Authorized Official Contact | 8018270662 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mmg Stansbury Family Practice Llc 576 E Highway 138 Ste 310 Stansbury Pk UT 84074-4028 Ph: (801) 827-0662 | Mmg Stansbury Family Practice Llc 576 E Highway 138 Ste 310 Stansbury Pk UT 84074-4028 Ph: (801) 456-2333 |
| NPI Number | 1730892274 |
|---|---|
| Provider Enumeration Date | 12/29/2022 |
| Last Update Date | 02/27/2025 |
| Medicare PECOS PAC ID | 7911371422 |
|---|---|
| Medicare Enrollment ID | O20230324000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730892274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lacey A Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639796477 PECOS PAC ID: 5294152047 Enrollment ID: I20200825003685 |
| Provider Name | Ashlie Taressa Flynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972257483 PECOS PAC ID: 2668846445 Enrollment ID: I20230317000632 |
University Of Utah Community Physicians Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 220 Millpond Ste 100, Stansbury Pk, UT 84074 Phone: 435-843-3000 |