Maggie Eviston, DO
Individual provider Active NPI Pediatrics Physician · Wpafb, OH
NPI 1104387950 · NPPES record last updated Jun 13, 2025
Key facts
- NPI
- 1104387950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 13352563-1204 (UT)
- Practice address
- 88TH Medical Group
4881 Sugar Maple Dr
Wpafb, OH 45433 - Phone
- (937) 522-2778
- NPI assigned
- Mar 26, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230614004180 | UT | Practitioner - Pediatric Medicine | 2860850351 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13352563-1204 | UT | MD | Pediatrics Physician |
| 0102206425 | VA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
4403 Harrison Blvd
Ste 4875
Ogden, UT 84403
Phone (801) 387-4500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 0102206425 | VA | |
| Pediatrics Physician | 208000000X | 0102206425 | VA | |
| Pediatrics Physician | 208000000X | 13352563-1204 | UT | Yes |
Addresses
Primary practice location
88TH Medical Group
4881 Sugar Maple Dr
Wpafb, OH 45433
Mailing address
88TH Medical Group
4881 Sugar Maple Dr
Wpafb, OH 45433
Other practice location 1
1 Childrens Plz
Dayton, OH 45404-1873
Phone (937) 641-3433 ext. 1
Other practice location 2
7321 Balmer St # 570
Hill AFB, UT 84056-5012
Phone (801) 777-4710
Other providers in Wpafb, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2025. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.