| Peachtree Medical Care, Llc | |
|
893 E 9400 S Sandy UT 84094-3671 | |
| (385) 335-7862 | |
| Not Available |
| Full Name | Peachtree Medical Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 893 E 9400 S, Sandy, Utah |
| Authorized Official Name and Position | Lorena Cannon (OWNER / PROVIDER) |
| Authorized Official Contact | 2083515458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peachtree Medical Care, Llc 893 E 9400 S Sandy UT 84094-3671 Ph: (385) 335-7862 | Peachtree Medical Care, Llc 893 E 9400 S Sandy UT 84094-3671 Ph: (385) 335-7862 |
| NPI Number | 1235721879 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 03/08/2021 |
| Medicare PECOS PAC ID | 2365859477 |
|---|---|
| Medicare Enrollment ID | O20210407000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235721879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Lorena Cannon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255992202 PECOS PAC ID: 6901213016 Enrollment ID: I20210510002449 |
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