Ashley Valley Physician Practice LLC
Organization Active NPI Obstetrics & Gynecology Physician · Vernal, UT
NPI 1164937645 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1164937645
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- ASHLEY VALLEY PHYSICIAN PRACTICE LLC
- Practice address
- 150 W 100 N
Vernal, UT 84078-2036 - Phone
- (435) 789-6962
- Fax
- (435) 789-6961
- NPI assigned
- Dec 6, 2017
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 5
Practitioners 9
-
Makenzie L Holmes, DNP
-
Sheila Kendall, APRN
-
Tiffany Petterborg, PA-C
-
Danette Foster, CNM
-
John Griffith, MD
-
Eileen E Joyce, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2149365 | Ashley Regional Women'S Health | Certificate of waiver | May 31, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050119001166 | UT | Part B Supplier - Clinic/Group Practice | 4284683947 |
Receives reassigned benefits from 57 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Vernal, UT; Roosevelt, UT; Price, UT |
National Provider Directory
- Tax ID family
- Ashley Valley Medical C
Locations
150 W 100 N
Ste GLO2
Vernal, UT 84078
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
150 W 100 N
Vernal, UT 84078-2036
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Ashley Valley Women's Health
Other providers in Vernal, UT
- Ashley Valley Medical Center
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
- Ashley Valley Physician Practice LLC
- Ashley Valley Physician Practice LLC
- Ashley Valley Physician Practice, LLC
- Ashley Valley Physician Practice, LLC
- Ashley Valley Physician Practice, LLC
All providers in Vernal, UT · Obstetrics & Gynecology 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 18, 2024. 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.