NPIMap

Organization Active NPI

Alta Medical Services PC

Doing business as Alta Medical Clinic

  • Urgent Care Clinic/Center
  • Alta, UT
National Provider Identifier
1740348556
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ALTA MEDICAL SERVICES PC
Doing business as
Alta Medical Clinic
Practice address
10160 E Highway 210
Alta, UT 84092-8072
Phone
(801) 742-2273
Fax
(888) 549-0494
NPI assigned
Dec 5, 2006
Last updated
May 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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

Authorized official

Name
Dr. Kenneth P Libre, MDNPI 1801873534
Title
President
Phone
(801) 742-2273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

10160 E Highway 210
Alta, UT 84092-8072

Mailing address

PO Box 8072
Alta, UT 84092-8072
Phone (801) 742-2273

Other names 1

  • ALTA MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050815000684 UT Part B Supplier - Clinic/Group Practice 4385674878 Receives reassigned benefits from 2 practitioners
Practice locations: Alta, UT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367366400000",
    "number": "1740348556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8072",
            "city": "ALTA",
            "state": "UT",
            "postal_code": "840928072",
            "telephone_number": "801-742-2273",
            "fax_number": "888-549-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10160 E HIGHWAY 210",
            "city": "ALTA",
            "state": "UT",
            "postal_code": "840928072",
            "telephone_number": "801-742-2273",
            "fax_number": "888-549-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA MEDICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2013-05-01",
        "status": "A",
        "authorized_official_last_name": "LIBRE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-742-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALTA MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alta, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.