| Wren Hollow Medical Llc | |
|
10644 S Jordan Gtwy South Jordan UT 84095-4036 | |
| (801) 389-3702 | |
| Not Available |
| Full Name | Wren Hollow Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10644 S Jordan Gtwy, South Jordan, Utah |
| Authorized Official Name and Position | Krista Gray (OWNER) |
| Authorized Official Contact | 8013893702 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wren Hollow Medical Llc 1191 N 1050 E American Fork UT 84003-3247 Ph: (801) 855-7237 | Wren Hollow Medical Llc 10644 S Jordan Gtwy South Jordan UT 84095-4036 Ph: (801) 389-3702 |
| NPI Number | 1245826981 |
|---|---|
| Provider Enumeration Date | 12/16/2020 |
| Last Update Date | 03/15/2022 |
| Medicare PECOS PAC ID | 7618376708 |
|---|---|
| Medicare Enrollment ID | O20210521000959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245826981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Krista A Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508216698 PECOS PAC ID: 5496041386 Enrollment ID: I20160831002737 |
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