| Step Mountain Medical Inc. | |
|
2332 W 12600 S Suite 2c Riverton UT 84065 | |
| (801) 446-2760 | |
| (801) 446-2762 |
| Full Name | Step Mountain Medical Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2332 W 12600 S, Riverton, Utah |
| Authorized Official Name and Position | Kirt Larson (OWNER) |
| Authorized Official Contact | 8014462760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Step Mountain Medical Inc. 2332 W 12600 S Suite 2c Riverton UT 84065 Ph: (801) 446-2760 | Step Mountain Medical Inc. 2332 W 12600 S Suite 2c Riverton UT 84065 Ph: (801) 446-2760 |
| NPI Number | 1619196771 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 08/05/2014 |
| Medicare PECOS PAC ID | 6901856764 |
|---|---|
| Medicare Enrollment ID | O20050128000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619196771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jane H Ricks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295745651 PECOS PAC ID: 1052398013 Enrollment ID: I20040707000882 |
| Provider Name | Kirt W Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053576504 PECOS PAC ID: 5991755753 Enrollment ID: I20050131000350 |
| Provider Name | Joylyn Cluny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578603932 PECOS PAC ID: 5395965875 Enrollment ID: I20141003002160 |
| Provider Name | Jaimie Michelle Lyman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912605619 PECOS PAC ID: 2567826449 Enrollment ID: I20230914002211 |
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