NPIMap

Organization Active NPI

Northeastern Utah Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Roosevelt, UT
National Provider Identifier
1740482009
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 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
Last updated
Oct 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Authorized official

Name
Brent H Hales
Title
Cfo
Phone
(435) 722-6164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930019874 UT DME Supplier - Physician - General Surgery 2961496609 Practice locations: Roosevelt, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northeastern Utah Medic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

210 W 300 N
#75
Roosevelt, UT 84066

38080 W State Road 35
Tabiona, UT 84072
Phone (435) 848-5509

150 W 100 N
Ste N205A
Vernal, UT 84078
Phone (435) 789-4489

150 W 100 N
Ste S101
Vernal, UT 84078
Phone (435) 722-6144

379 N 500 W
Vernal, UT 84078
Phone (435) 781-2030

510 S 500 W
Vernal, UT 84078
Phone (435) 781-3500

Practitioners & affiliated clinicians

Practitioners 86

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.

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1740482009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN UTAH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-722-6164"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roosevelt, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; 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.