Steven W Wynn, MD
Individual provider Active NPI Family Medicine Physician · N Ogden, UT
NPI 1962510040 · NPPES record last updated Jul 10, 2008
Key facts
- NPI
- 1962510040
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2942391205 (UT)
- Practice address
- 2400 North Washington Blvd
N Ogden, UT 84414-7233 - Phone
- (801) 387-8300
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060222000617 | UT | Practitioner - Family Practice | 0941216378 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2942391205 | UT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Family Medicine | Current | Accepting new patients |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Ihc Health Services Inc | Family Medicine | Current |
Accepting new patients |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
4403 Harrison Blvd
Ogden, UT 84403
Phone (801) 387-2800
2400 N Washington Blvd
Ogden, UT 84414
Phone (801) 387-8300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2942391205 | UT | Yes |
Addresses
Primary practice location
2400 North Washington Blvd
N Ogden, UT 84414-7233
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 786-7500
Other providers in N Ogden, UT
All providers in N Ogden, 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 Jul 10, 2008. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.