Ashley Valley Family Practice
Organization Active NPI Family Medicine Physician · Vernal, UT
NPI 1881779809 · NPPES record last updated Oct 28, 2020
Key facts
- NPI
- 1881779809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ASHLEY VALLEY FAMILY PRACTICE
- Practice address
- 872 W Highway 40
Vernal, UT 84078-2416 - Phone
- (435) 781-8899
- Fax
- (435) 781-8898
- NPI assigned
- Oct 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Shaun C Shurtliff, DO
- Title
- President
- Phone
- (435) 781-8899
Practitioners 4
-
Christina Thacker, FNP-C
-
Ashley Lynn Russell, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051005000647 | UT | Part B Supplier - Clinic/Group Practice | 6406881747 |
Receives reassigned benefits from 3 practitioners Practice locations: Vernal, UT |
National Provider Directory
Locations
175 N 100 W
Ste 103
Vernal, UT 84078
Phone (435) 781-8899
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
872 W Highway 40
Vernal, UT 84078-2416
Mailing address
872 W Highway 40
Vernal, UT 84078-2416
Phone (435) 781-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07/16/1967 | Other | OWNER'S BIRTHDATE |
Other providers in Vernal, UT
- Andrea Arnold
- Ashley Creek Physical Therapy, Inc
- Ashley Family Services, PLLC
- Ashley Regional Medical Ctr Ekg Group
- Ashley Valley Family Dental
- Ashley Valley Medical Center
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
- Ashley Valley Medical Center LLC
All providers in Vernal, UT · Family Medicine Physician 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 28, 2020. 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.