Ashley Valley Physician Practice, LLC
Organization Active NPI Urology Physician · Vernal, UT
NPI 1740423367 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1740423367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- License
- 7161419-8017 (UT)
- Legal business name
- ASHLEY VALLEY PHYSICIAN PRACTICE, LLC
- Practice address
- 150 W 100 N
Vernal, UT 84078-2036 - Phone
- (435) 381-4511
- NPI assigned
- Apr 13, 2009
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 7
Practitioners 8
-
Matthew C Bowen, D.O.
-
Thomas Maurice Buchanan, M.D.
-
Daniel Matthew Hoopes, M.D.
-
J Cameron Kesler, DO
-
Tyler B Moore, MD
-
Juan C Vasquez, MD
-
Tyler Wilhelm, CRNA
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | 7161419-8017 | UT | Yes |
Addresses
Primary practice location
150 W 100 N
Vernal, UT 84078-2036
Mailing address
150 W 100 N
Vernal, UT 84078-2036
Phone (435) 381-4511
Other names
- Petar M. Ilievski, MD
Other providers in Vernal, UT
- 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
- Ashley Valley Physician Practice, LLC
- Ashley Valley Physician Practice, LLC
- Ashley Valley Wilderness Inc
- Audiology and Hearing Clinic
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.