Elk Ridge Family Practice PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5656211-1204 Issued in UT

Legal business name

ELK RIDGE FAMILY PRACTICE PC

Practice address

1172 E 100 N Ste 11
Payson, UT 84651-1668

Phone

(801) 465-6100

Fax

(801) 465-6114

NPI assigned

Feb 20, 2008

Organization subpart

No

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

Authorized official

Name

Dennis Michael Concoby, D.O

Title

President

Phone

(801) 465-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1356519656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 E 100 N STE 11",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511668",
            "telephone_number": "801-465-6100",
            "fax_number": "801-465-6114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 E 100 N STE 11",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846511668",
            "telephone_number": "801-465-6100",
            "fax_number": "801-465-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIDGE FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "CONCOBY",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-465-6100",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5656211-1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530117654001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.