| Wasatch Rpm LLC | |
|
5825 Harrison Blvd Ogden UT 84403-4316 | |
| (801) 475-5254 | |
| (801) 797-0278 |
| Full Name | Wasatch Rpm LLC |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 5825 Harrison Blvd, Ogden, Utah |
| Authorized Official Name and Position | Joseph Fyans (OWNER) |
| Authorized Official Contact | 8014755254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wasatch Rpm LLC 5825 Harrison Blvd Ogden UT 84403-4316 Ph: (801) 475-5254 | Wasatch Rpm LLC 5825 Harrison Blvd Ogden UT 84403-4316 Ph: (801) 475-5254 |
| NPI Number | 1053175976 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 06/07/2024 |
| Certification Date | 06/07/2024 |
| Medicare PECOS PAC ID | 2163868829 |
|---|---|
| Medicare Enrollment ID | O20240422001986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053175976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | () | Primary |
| Provider Name | Jason Mack Eversole |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699159178 PECOS PAC ID: 2365792330 Enrollment ID: I20240422002167 |
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