MOUNTAINSTAR MEDICAL GROUP- CACHE VALLEY, LLC (NPI# 1144475674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144475674 |
| Entity Type | Organization |
| Organization Name | MOUNTAINSTAR MEDICAL GROUP- CACHE VALLEY, LLC |
| Other Organization Name | MOUNTAINSTAR CACHE VALLEY MEDICAL GROUP |
| Practice Address |
382 W 280 N Providence UT 84332-9753 |
| Mailing Address |
2000 Health Park Dr Brentwood TN 37027-4525 |
| Practice Telephone | 4357520330 |
| Practice Fax Number | 4357550922 |
| Mailing Telephone | 6153737600 |
| Mailing Fax Number | 8663461426 |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2020-10-28 |
| Authorized Official Name | WILLIAM TEDRICK JOHNSON (GROUP VP/AO) |
| Authorized Official Telephone | 6153723375 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 1144475674 | 05 |
| Other Name | Type Code |
|---|---|
| MountainStar Cache Valley Medical Group | Doing Business As Name - Organization |
| Street Address |
382 W 280 N |
| City | PROVIDENCE |
| State | UT |
| Zip Code | 84332-9753 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265424741 | Layne S Barnes | Family Medicine | 382 W 280 N, Providence, UT 84332-9753 | 2005-08-19 |
| 1093154031 | James Dennis Mathews, D.o., P.C. | Clinic/Center | 382 W 280 N, Providence, UT 84332-0609 | 2013-06-24 |
| 1982933750 | Lars Bergeson, M.d., PC | Point of Service | 382 W 280 N, Providence, UT 84332-0609 | 2009-12-08 |
| 1518113216 | James Dennis Mathews | Family Medicine | 382 W 280 N, Providence, UT 84322-0609 | 2008-08-13 |
| 1003001959 | Kevin R Duke, Do, PC | Clinic/Center | 382 W 280 N, Providence, UT 84332-0609 | 2007-09-12 |
| 1790739449 | Richard T Stevens | Family Medicine | 382 W 280 N, Providence, UT 84332 | 2006-05-19 |
| 1003882713 | Kevin R Duke | Family Medicine | 382 W 280 N, Providence, UT 84332-0609 | 2006-02-23 |
| 1497721195 | Lars Bergeson | Family Medicine | 382 W 280 N, Providence, UT 84332-9707 | 2006-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292167 | 3bc Incorporated | Pharmacy | 435 North Gateway Drive #802, Providence, UT 84332 | 2020-10-09 |
| 1962049932 | Wholelife Family Wellness Clinic of Providence Pllc | Counselor | 169 N Gateway Dr. Suite 170, Providence, UT 84332 | 2019-12-09 |
| 1033503420 | Spring Creek Surgical Center, LLC | Clinic/Center | 65 North Gateway Drive, Suite 3, Providence, UT 84332 | 2015-03-24 |
| 1558751438 | Naturopathic Medical, P.C. | Naturopath | 565 W. 465 N., Suite 150, Providence, UT 84332 | 2015-01-29 |
| 1821421710 | Erin Campbell | Physical Therapist | 267 West Spring Creek Parkway, Providence, UT 84332 | 2013-08-14 |
| 1285981530 | Jordan Joseph Hansen | Dentist | 169 N Gateway Drive, Suite 200, Providence, UT 84332 | 2012-08-06 |
| 1598086720 | Cory B Maughan | Dermatology | 169 N Gateway Dr Ste 100, Providence, UT 84332 | 2010-06-22 |
| 1528299245 | South Valley Eyecare Center, Inc. | Optometrist | 276 Springcreek Pkwy, Providence, UT 84332 | 2009-07-29 |
| 1316134356 | Heather Saxton Maughan | Speech-Language Pathologist | 344 E Edgehill Dr, Providence, UT 84332 | 2007-10-03 |
| 1902021538 | Brad L Thomas | Physical Therapist | 169 Spring Creek Park Way, Suite 140, Providnce, UT 84332 | 2007-04-17 |
| Find all providers in zip 84332 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982254876 | Jean Ernst Noel | Family Medicine | 22 Parsonage St # 194, Providence, RI 02903-4758 | 2019-09-12 |
| 1619526217 | Jean Simon Joel Edouard | Family Medicine | 22 Parsonage St # 184, Providence, RI 02903-4758 | 2019-09-05 |
| 1609065804 | Stephen W Davis | Family Medicine | 299 Promenade Street, Nhpri, Providence, RI 02908 | 2007-10-24 |
| 1114115664 | Jeremy Broadhurst | Family Medicine | 190 S Highway 165, Providence, UT 84332-9512 | 2007-10-10 |
| 1053443911 | Chad Brown Health Center | Family Medicine | 285a Chad Brown St, Providence, RI 02908-3102 | 2007-03-09 |
| 1679608582 | Peachtree Family Medicine PC | Family Medicine | 169 N Gateway Dr, 170, Providence, UT 84332-9855 | 2007-02-22 |
| 1679647432 | Marsha Maxine Miller | Family Medicine | Brown University Health Services, Brown University, 13 Brown Street, Providence, RI 02912-0001 | 2006-11-20 |
| 1881781920 | Arthur A Frazzano | Family Medicine | 97 Waterman St, Providence, RI 02912-9079 | 2006-10-09 |
| 1871609842 | Wayne C Cole | Family Medicine | 121 East Main St, Providence, KY 42450 | 2006-08-22 |
| 1629181268 | David J Coia | Family Medicine | 235 Plain St Ste 103, Providence, RI 02905-3242 | 2006-08-17 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 84332 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.