NPIMap

Organization Active NPI

Medallion Supported Living-Payson

  • Intellectual Disabilities Intermediate Care Facility
  • Payson, UT
National Provider Identifier
1043518145
Registry record updated Mar 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2011-SHCF-100069 Issued in UT
Legal business name
MEDALLION SUPPORTED LIVING-PAYSON
Practice address
2192 W State Rd
Payson, UT 84651-4539
Phone
(801) 375-2710
Fax
(801) 377-3651
NPI assigned
Mar 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Merlin Moyes Jr.
Title
Owner
Phone
(801) 375-2710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2011-SHCF-100069 UT Primary

Addresses

Primary practice location

2192 W State Rd
Payson, UT 84651-4539

Mailing address

PO Box 51377
Provo, UT 84605-1377
Phone (801) 375-2710

Other names 1

  • Medallion Manor Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 46G001

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MEDALLION SUPPORTED LIVING - PAYSON
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 23, 2011
Last certification
Nov 26, 2025
Beds
16
Ownership / control type
Private (proprietary)
Facility address
2192 West State Road
Payson, UT 84651

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2197383Medallion Supported Living Payson2192 W State Rd, Payson, UT 84651Certificate of waiverOct 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Medallion Manor Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2192 W State Rd
Payson, UT 84651
Phone (801) 375-2710

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300060800000",
    "number": "1043518145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51377",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846051377",
            "telephone_number": "801-375-2710",
            "fax_number": "801-377-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2192 W STATE RD",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846514539",
            "telephone_number": "801-375-2710",
            "fax_number": "801-377-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDALLION SUPPORTED LIVING-PAYSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-14",
        "last_updated": "2011-03-14",
        "status": "A",
        "authorized_official_last_name": "MOYES",
        "authorized_official_first_name": "MERLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-375-2710",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "UT",
            "license": "2011-SHCF-100069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medallion Manor Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Payson, UT

Sources for this page

Verify at the official NPI Registry.