Valley Family Medicine PC
Organization Active NPI Family Medicine Physician · Tooele, UT
NPI 1033412481 · NPPES record last updated Sep 20, 2011
Key facts
- NPI
- 1033412481
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 346411 (UT)
- Legal business name
- VALLEY FAMILY MEDICINE PC
- Practice address
- 2376 N 400 E Ste 102
Tooele, UT 84074-3413 - Phone
- (435) 843-1225
- Fax
- (435) 843-1228
- NPI assigned
- Dec 7, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Carolyn Forbes, M.D.
- Title
- Owner
- Phone
- (435) 843-1225
Practitioners 9
-
Carolyn Forbes, M.D.
-
Spencer Larson, DO
-
Sara Carstensen, PA-C
-
Cameron Dortch, MPAS, PA-C
-
McKenzie Bright, PA-C
-
Richard Scott, PA-C
-
Kyle W Harmer, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0942830 | Valley Family Medicine-Carolyn Forbes MD | Certificate of waiver | Dec 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110121000745 | UT | Part B Supplier - Clinic/Group Practice | 2062505852 |
Receives reassigned benefits from 5 practitioners Practice locations: Tooele, UT |
National Provider Directory
Locations
2376 N 400 E
Ste 102
Tooele, UT 84074
Phone (435) 843-1225
Interoperability endpoints
- https://api.platform.athenahealth.com/12102/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 346411 | UT | Yes |
Addresses
Primary practice location
2376 N 400 E Ste 102
Tooele, UT 84074-3413
Mailing address
2376 N 400 E Ste 102
Tooele, UT 84074-3413
Phone (435) 843-1225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 308723752008 | Medicaid | UT |
Other providers in Tooele, UT
- Ellen Gable Turgeon
- US Army Health Clinic
- Emmanuella Uzoigwe
- Erika Valdez
- Daniela Valerio
- Valley Mental Health Incorporated
- Valley West Health
- Peter Gibbs Ventura
- Clair Reed Vernon
- Heidi Vernon
All providers in Tooele, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.