MOUNTAINSTAR MEDICAL GROUP-OGDEN REGIONAL MEDICAL CENTER, LLC (NPI# 1356588008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356588008 |
Entity Type | Organization |
Organization Name | MOUNTAINSTAR MEDICAL GROUP-OGDEN REGIONAL MEDICAL CENTER, LLC |
Other Organization Name | MOUNTAINSTAR PRIMARY CARE, LLC |
Practice Address |
5405 S 500 E Ste. 100 Ogden UT 84405-6957 |
Mailing Address |
2000 Health Park Dr Brentwood TN 37027-4525 |
Practice Telephone | 8012825952 |
Practice Fax Number | 8015695990 |
Mailing Telephone | 6153737600 |
Mailing Fax Number | 8663461426 |
Enumeration Date | 2009-01-17 |
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 | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
UT | 1356588008 | 05 |
Other Name | Type Code |
---|---|
Mountainstar Primary Care, LLC | Former Legal Business Name - Organization |
Street Address |
5405 S 500 E STE. 100 |
City | OGDEN |
State | UT |
Zip Code | 84405-6957 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164425294 | Fawad Tanvir | Internal Medicine | 5405 S 500 E, Ste 100, Ogden, UT 84405-6957 | 2005-05-23 |
1982844098 | Peter George Forstall | Internal Medicine | 5405 S 500 E, Suite 204, Ogden, UT 84405-6957 | 2009-03-02 |
1760650527 | Columbia Ogden Regional | Family Medicine | 5405 S 500 E, Suite 110, Ogden, UT 84405-6957 | 2008-02-14 |
1821274655 | Nadya P. Wayment | Family Medicine | 5405 S 500 E, Ste. 100, Ogden, UT 84405-7428 | 2008-01-10 |
1003001553 | Ogden Internal Medicine & Urology LLC | Urology | 5405 S 500 E, Suite 100, Ogden, UT 84405-6957 | 2007-09-07 |
1669666509 | Utah Hematology Oncology | Specialist | 5405 S 500 E, Suite 202, Ogden, UT 84405-6957 | 2007-09-04 |
1013121003 | Alpine Plastic and Reconstructive Surgery, LLC | Specialist | 5405 S 500 E, Suite101, Ogden, UT 84405-6957 | 2007-05-09 |
1437267192 | Kathleen R Deremer | Internal Medicine | 5405 S 500 E, Suite 100, Ogden, UT 84405-6957 | 2006-08-25 |
1952326357 | Adam C Craner | Nurse Practitioner | 5405 S 500 E, Ste. 100, Ogden, UT 84405-6957 | 2006-07-13 |
1750314480 | Robert R Mohr | Internal Medicine | 5405 S 500 E, Ste. 100, Ogden, UT 84405-6957 | 2006-07-08 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669028171 | Alyssa House | Behavioral Analyst | 4933 1500 West #110, Riverdale, UT 84405 | 2019-08-12 |
1518525989 | Petersen Farms Assisted Living & Memory Care | Assisted Living Facility | 6980 S. 475 E., South Weber, UT 84405 | 2019-05-31 |
1376038141 | National Vision, Inc. | Technician/Technologist | 821 West Riverdale Road, Riverdale, UT 84405 | 2018-06-25 |
1194218461 | South Weber City | Ambulance | 7365 S 1375 E, South Weber, UT 84405 | 2018-06-12 |
1528572682 | Sandra Jo Scott | Dental Hygienist | 264 W Ridgeline Dr, Washington Terrace, UT 84405 | 2017-11-28 |
1376079061 | Loretta Shupe | Registered Nurse | 5319 S 500 E, Ogden, UT 84405 | 2017-05-02 |
1134661374 | Randy Ferrin | Registered Nurse | 5697 Maplewood Drive, South Ogden, UT 84405 | 2016-11-04 |
1871046284 | Karla Rosen | Counselor | 5202 S. Freeway Park Dr., Riverdale, UT 84405 | 2016-08-02 |
1053784520 | Jenifer Rebecca Nilson Smith | Physical Therapist | 5648 S. Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
1972976454 | Jenniferlyn Fletcher | Physical Therapy Assistant | 5648 South Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
Find all providers in zip 84405 |
Taxonomy Code | 207R00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639797509 | Ihc Health Services Inc | Internal Medicine | 4387 Harrison Blvd Ste C1, Ogden, UT 84403-3148 | 2020-07-08 |
1942610993 | Nickolas Gangwer | Internal Medicine | 4403 Harrison Blvd Ste 3875, Ogden, UT 84403-3332 | 2014-04-29 |
1235491994 | Jesse Scott Swift | Internal Medicine | 2473 Woodland Dr, Ogden, UT 84403-5129 | 2012-06-08 |
1225355118 | Amce Physicians Group | Internal Medicine | 205 26th St, Suite 14, Ogden, UT 84401-3119 | 2010-04-30 |
1821236035 | Walter Evan Brodis | Internal Medicine | 2041 E 6025 S, Ogden, UT 84403-5270 | 2009-01-26 |
1265559595 | Shawn David Mcquilkin | Internal Medicine | Wsu Student Health Center, 1128 University Circle, Ogden, UT 84408-1128 | 2007-03-23 |
1689771362 | Gilbert E Caillouet Jr. | Internal Medicine | 1292 E 5375 S, Ogden, UT 84403-4544 | 2006-09-17 |
1851409544 | Seth R Lewis | Internal Medicine | 555 E 5350 S Ste 7, Ogden, UT 84405-4509 | 2006-08-25 |
1518988039 | Donna L Milavetz | Internal Medicine | 1976 Arapaho Cir, Ogden, UT 84403-4648 | 2006-07-21 |
1588689095 | John K Reis | Internal Medicine | 760 Holroyd Dr, Ogden, UT 84403-4511 | 2006-07-13 |
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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.