NPIMap

Beaver Medical, LLC

Organization Active NPI Rural Health Clinic/Center · Beaver, UT

NPI 1770570202 · NPPES record last updated Feb 18, 2026

Key facts

NPI
1770570202
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
47255720160 (UT)
Legal business name
BEAVER MEDICAL, LLC
Practice address
1059 N 100 W
Beaver, UT 84713-1690
Phone
(435) 438-7280
Fax
(435) 438-7210
NPI assigned
Sep 30, 2005
Organization subpart
No

Authorized official

Name
Julie Christensen
Title
Office Manager
Phone
(435) 438-7280

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 17

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

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 numberLaboratoryCertificateExpires
46D0525734Beaver Medical Clinic
1059 North 100 W, Beaver, UT 84713		Provider-performed microscopyAug 31, 2026

Medicare participation

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

Rural health clinic certification: CCN 463810

Legal name
BEAVER MEDICAL, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 8, 1992
Last certification
Sep 21, 2017
Ownership / control type
1C
Organization structure
LLC · Proprietary
Incorporated
Feb 25, 2000 in UT
Enrollment address
1059 N 100 W
Beaver Medical Clinic
Beaver, UT 84713-1690

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lance C Smith
Individual 		5% Or Greater Direct Ownership Interest Jan 1, 2010 33%
Rhett Roger Smith
Individual 		5% Or Greater Direct Ownership Interest Aug 23, 2018 33%
Julie Christensen
Individual 		W-2 Managing Employee
Office Manager		 Dec 20, 2012
Richard Wade Oakden
Individual 		5% Or Greater Direct Ownership Interest Aug 1, 1983 33%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050714000791 UT Part B Supplier - Clinic/Group Practice 2365352036 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Milford, UT; Beaver, UT; Parowan, UT
O20061005000021 UT Part a Provider - Rural Health Clinic 2365352036 Practice locations: Beaver, UT

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X 47255720160 UT Yes

Addresses

Primary practice location

1059 N 100 W
Beaver, UT 84713-1690

Mailing address

PO Box 1690
Beaver, UT 84713-1690
Phone (435) 438-7280

Other identifiers

IdentifierTypeStateIssuer
CG2421OtherUTPALMETTO RAILROAD MEDICARE

Other names

  • Beaver Medical Clinic Doing business as

Other providers in Beaver, UT

All providers in Beaver, UT · Rural Health Clinic/Center in Utah

Sources for this page

Verify at the official NPI Registry.