Northeastern Utah Medical Group
Organization Active NPI Durable Medical Equipment & Medical Supplies · Roosevelt, UT
NPI 1740482009 · NPPES record last updated Oct 23, 2025
Key facts
- NPI
- 1740482009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- NORTHEASTERN UTAH MEDICAL GROUP
- Practice address
- 210 W 300 N
Roosevelt, UT 84066-2336 - Phone
- (435) 722-3971
- Fax
- (435) 722-6104
- NPI assigned
- May 31, 2007
- Organization subpart
- No
Authorized official
- Name
- Brent H Hales
- Title
- Cfo
- Phone
- (435) 722-6164
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 84
-
Samuel Mark Bertoch, FNP-C
-
John S Blake, MD
-
Tanya Sarah Boren, FNP
-
Karl Breitenbach, M.D.
-
Michaela J Curry, FNP-C
-
Megan Hopkins, APRN
-
Bradley F Jenkins, FNP
-
Shalese Marie Killian, FNP-C
-
John D Nolte, MD
-
Amy Olsen, FNP
-
Michael Olsen, M.D.
-
Shane K Powell, MD
-
Annemarie Rousseau, APRN
-
Gregory L Staker, MD
-
Jeffrey Lynn Wheeler, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930019874 | UT | DME Supplier - Physician - General Surgery | 2961496609 | Practice locations: Roosevelt, UT |
National Provider Directory
- Tax ID family
- Duchesne Co Hospital
Locations
210 W 300 N
#75
Roosevelt, UT 84066
475 N 500 W
Vernal, UT 84078
Phone (435) 781-2030
150 W 100 N
Ste S101
Vernal, UT 84078
Phone (435) 722-6144
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
210 W 300 N
Roosevelt, UT 84066-2336
Mailing address
210 W 300 N
Roosevelt, UT 84066-2336
Phone (435) 722-3971
Other providers in Roosevelt, UT
- Robert Nielson
- Robert A Nielson
- John D Nolte
- Marci Dawn Norman
- Northeastern Utah Medical Group
- Northeastern Utah Medical Group
- Novo Ranch LLC
- Christopher Timbrell Oborn
- Douglas Collin Ogden
- Canela F Oldroyd
All providers in Roosevelt, UT · Durable Medical Equipment & Medical Supplies in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 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.