Mindful Mobile Medicine LLC
Organization Active NPI Internal Medicine Physician · Midvale, UT
NPI 1245068626 · NPPES record last updated Feb 10, 2025
Key facts
- NPI
- 1245068626
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MINDFUL MOBILE MEDICINE LLC
- Practice address
- 623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529 - Phone
- (801) 879-2664
- NPI assigned
- Jul 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Tyler Young
- Title
- VP
- Phone
- (801) 879-2664
Practitioners 6
-
Caitlin Randi Clark, FNP
-
Carley Ann Florence, APRN, AGPCNP-C
-
Tonya Wright, PMHNP
-
Jaime M Tracy, LCSW
-
Cody Morgan, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241112004201 | UT | Part B Supplier - Clinic/Group Practice | 1254865363 |
Receives reassigned benefits from 5 practitioners Practice locations: Midvale, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Gerontology Nurse Practitioner |
363LG0600X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529
Mailing address
623 E Fort Union Blvd Ste 105
Midvale, UT 84047-5529
Phone (385) 412-1660
Other providers in Midvale, UT
- Midvale PDC PLLC
- Courtney Millard
- Sarah Miller
- Megan Jolley Milne
- Mind and Matter Therapy
- Alan Minson
- Mobile MBS Inc.
- Nadim Modi
- Molina Healthcare of Utah Inc
- Leah Rae Molina
All providers in Midvale, UT · Internal 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 Feb 10, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.