Enterprise Valley Medical Clinic, Inc.

Key facts

NPI: 1659457786
Entity type: Organization (NPI type 2)
Primary specialty: Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name: ENTERPRISE VALLEY MEDICAL CLINIC, INC.
Practice address: 223 South 200 East
Enterprise, UT 84725-0370
Phone: (435) 878-2281
Fax: (435) 878-2434
NPI assigned: Oct 31, 2006
Organization subpart: No

Authorized official

Name: Mr. C.J. Hansen
Title: Executive Director
Phone: (435) 878-2281

Corporate family (same tax ID) 1

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

Enterprise Valley Med Ctr Inc Clinic Pharmacy · Enterprise, UT · NPI 1649335761

NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Thomas Holland Bigham, D.O. Family Medicine Physician · St. George, UT · NPI 1689642332

Medicare reassignment NPD UT
Karl Torgerson, P.A. Physician Assistant · Enterprise, UT · NPI 1417253824

NPD (past)

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
46D0525794	Enterprise Valley Medical Clinic 223 S 200 E, Enterprise, UT 84725	Provider-performed microscopy	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in UT

Federally qualified health center certification: CCN 461803

Legal name: ENTERPRISE VALLEY MEDICAL CLINIC, INC.
Certification status: Active
Provider type (POS): Federally qualified health center
Participating since: Oct 1, 1992
Last certification: Oct 1, 1992
Ownership / control type: For profit – corporation
Organization structure: Corporation · Non-profit
Incorporated: Jun 28, 1983 in UT
Enrollment address: 223 S 200 E
Enterprise, UT 84725-0370

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since	Share
Layne Anderson Individual	Corporate Director Board Member	Jan 1, 2020
Rydel Reber Individual	Corporate Director Executive Director	Jan 14, 2010	5%
Rydel Reber Individual	W-2 Managing Employee Executive Director	Jan 14, 2010	5%
Dennis M Mehr Individual	Corporate Director Board Member	Jan 14, 2010
Maria F Twitchell Individual	Corporate Director Board Member	Jan 14, 2010
Marc Bowler Individual	Corporate Director Board Member	Jan 1, 2020
Jean Munk Individual	Corporate Director Board Member	Jan 14, 2010
Muary L Foremaster Individual	Corporate Director Board Member	Jan 1, 2021
Elaine Schriver Individual	Corporate Director Board Member	Jan 1, 2021
Jill Schill Individual	Corporate Director Board Member	Feb 5, 2013

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20071204000392	UT	Part B Supplier - Clinic/Group Practice	6709975436	Receives reassigned benefits from 1 practitioner Practice locations: Enterprise, UT
O20100803000174	UT	Part a Provider - Federally Qualified Health Center (FQHC)	6709975436	Practice locations: Enterprise, UT

National Provider Directory

Tax ID family: Enterprise Valley Medical Clinic Inc (2 organizations share this tax ID)

Interoperability endpoints

FHIR API: https://fhir4.healow.com/fhir/r4/BDFCAD

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Federally Qualified Health Center (FQHC)	261QF0400X			Yes

Addresses

Primary practice location

223 South 200 East
Enterprise, UT 84725-0370

Mailing address

PO Box 370
Enterprise, UT 84725-0370
Phone (435) 878-2281

Other identifiers

Identifier	Type	State	Issuer
05883	Medicaid	UT

Other providers in Enterprise, UT

All providers in Enterprise, UT · Federally Qualified Health Center (FQHC) in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
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.

Verify at the official NPI Registry.