| Premier Provider Health Utah Pllc | |
|
5475 S 500 E Ogden UT 84405-6905 | |
| (801) 479-2111 | |
| Not Available |
| Full Name | Premier Provider Health Utah Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5475 S 500 E, Ogden, Utah |
| Authorized Official Name and Position | Nora Lopez (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3462399469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Provider Health Utah Pllc 1 Chisholm Trail Rd Ste 5200 Round Rock TX 78681-5090 Ph: (512) 202-3830 | Premier Provider Health Utah Pllc 5475 S 500 E Ogden UT 84405-6905 Ph: (801) 479-2111 |
| NPI Number | 1699311209 |
|---|---|
| Provider Enumeration Date | 11/19/2019 |
| Last Update Date | 11/13/2024 |
| Medicare PECOS PAC ID | 0042649113 |
|---|---|
| Medicare Enrollment ID | O20200413000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699311209 | NPI | - | NPPES |
| Provider Name | Danielle Nicole Van Komen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912549072 PECOS PAC ID: 6709211659 Enrollment ID: I20200122003079 |
| Provider Name | Han Pham Hulen |
|---|---|
| Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
| Provider Identifiers | NPI Number: 1770593436 PECOS PAC ID: 7719923101 Enrollment ID: I20200413000018 |
| Provider Name | Jayson Malufau |
|---|---|
| Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
| Provider Identifiers | NPI Number: 1538554746 PECOS PAC ID: 9032461744 Enrollment ID: I20220110001500 |
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