| Pioneer Comprehensive Medical Llc | |
|
12433 Fort St Draper UT 84020-9363 | |
| (801) 576-1086 | |
| (801) 576-9796 |
| Full Name | Pioneer Comprehensive Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 12433 Fort St, Draper, Utah |
| Authorized Official Name and Position | Robin Olsen (OFFICE MANAGER) |
| Authorized Official Contact | 8015761086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pioneer Comprehensive Medical Llc 12433 Fort St Draper UT 84020-9363 Ph: (801) 576-1086 | Pioneer Comprehensive Medical Llc 12433 Fort St Draper UT 84020-9363 Ph: (801) 576-1086 |
| NPI Number | 1891975595 |
|---|---|
| Provider Enumeration Date | 11/09/2007 |
| Last Update Date | 01/02/2024 |
| Medicare PECOS PAC ID | 9537192570 |
|---|---|
| Medicare Enrollment ID | O20050912000456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891975595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 891818251205 (Utah) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Carmela J Javellana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215031778 PECOS PAC ID: 9436130887 Enrollment ID: I20040601000404 |
| Provider Name | Jarrod C Bagley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558345397 PECOS PAC ID: 0244385383 Enrollment ID: I20090826000218 |
| Provider Name | Gary Dean Olsen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1023092293 PECOS PAC ID: 7012062920 Enrollment ID: I20111229000477 |
| Provider Name | Leeann Klemetson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447583471 PECOS PAC ID: 6507011566 Enrollment ID: I20130225000338 |
| Provider Name | Trisha Darlene White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245752740 PECOS PAC ID: 0244502441 Enrollment ID: I20170823002300 |
| Provider Name | Bernard M Mutie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396255360 PECOS PAC ID: 0749547891 Enrollment ID: I20171128003813 |
| Provider Name | Heather Harrison Hardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659936151 PECOS PAC ID: 6709216450 Enrollment ID: I20200420002163 |
| Provider Name | Hannah Bjorkman Stauber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356913693 PECOS PAC ID: 5496136731 Enrollment ID: I20220719000827 |
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