| Jordan Ridge Family Medicine Llc | |
|
4071 S 4000 W West Valley City UT 84120-4143 | |
| (801) 515-7196 | |
| Not Available |
| Full Name | Jordan Ridge Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4071 S 4000 W, West Valley City, Utah |
| Authorized Official Name and Position | John Rhodes (MD) |
| Authorized Official Contact | 7024802550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Ridge Family Medicine Llc Po Box 35380 Las Vegas NV 89133-5380 Ph: (702) 560-2916 | Jordan Ridge Family Medicine Llc 4071 S 4000 W West Valley City UT 84120-4143 Ph: (801) 515-7196 |
| NPI Number | 1306275227 |
|---|---|
| Provider Enumeration Date | 11/02/2013 |
| Last Update Date | 08/09/2023 |
| Medicare PECOS PAC ID | 7214168111 |
|---|---|
| Medicare Enrollment ID | O20201221001430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306275227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Diane Kendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659397545 PECOS PAC ID: 5294730552 Enrollment ID: I20060921000049 |
| Provider Name | Jennifer Beyer Jenkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891125100 PECOS PAC ID: 6204066756 Enrollment ID: I20140312001244 |
| Provider Name | Debra Vigil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821419490 PECOS PAC ID: 5193049070 Enrollment ID: I20170215002581 |
| Provider Name | Natalie Lois Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477085090 PECOS PAC ID: 0547531709 Enrollment ID: I20170807000291 |
| Provider Name | Steven G Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629030838 PECOS PAC ID: 6406877000 Enrollment ID: I20210107002513 |
| Provider Name | Tia Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841675576 PECOS PAC ID: 9436465382 Enrollment ID: I20221017003299 |
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