| West Valley Family And Preventive Medicine | |
|
4100 South 1778 West West Valley City UT 84119 | |
| (801) 964-8726 | |
| (801) 968-9836 |
| Full Name | West Valley Family And Preventive Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 4100 South 1778 West, West Valley City, Utah |
| Authorized Official Name and Position | Jessica Janae Campbell (MANAGER) |
| Authorized Official Contact | 8019648726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Valley Family And Preventive Medicine 3336 Pioneer Pkwy #302 West Valley City UT 84120-2000 Ph: (801) 964-8726 | West Valley Family And Preventive Medicine 4100 South 1778 West West Valley City UT 84119 Ph: (801) 964-8726 |
| NPI Number | 1326169632 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 04/12/2024 |
| Medicare PECOS PAC ID | 0547174229 |
|---|---|
| Medicare Enrollment ID | O20031117000748 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326169632 | NPI | - | NPPES |
| 480025031002 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tan Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285621052 PECOS PAC ID: 8426962101 Enrollment ID: I20031118000297 |
| Provider Name | Paula S Wolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407445950 PECOS PAC ID: 6800297235 Enrollment ID: I20210623001605 |
| Provider Name | Samantha Gajkowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043912298 PECOS PAC ID: 4183072119 Enrollment ID: I20231130002384 |
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