UTAH ADDICTION MEDICINE (NPI# 1598267122) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598267122 |
| Entity Type | Organization |
| Organization Name | UTAH ADDICTION MEDICINE |
| Practice Address |
619 N 500 W Provo UT 84601-1547 |
| Practice Telephone | 8018529440 |
| Mailing Telephone | 8018529440 |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | ROBERT SIMPSON (OWNER) |
| Authorized Official Telephone | 8018529440 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1377 E 3900 S Ste 200, Salt Lake City, UT 841241496 | 8018529440 |
| Street Address |
619 N 500 W |
| City | PROVO |
| State | UT |
| Zip Code | 84601-1547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417977505 | Susan R Dyle | Physician Assistant | 619 N 500 W, Provo, UT 84601-1547 | 2006-07-20 |
| 1902430531 | Brighter Path Addiction Medicine | Obstetrics & Gynecology | 619 N 500 W, Provo, UT 84601-1547 | 2020-02-21 |
| 1306387105 | Brenton Lisonbee | Counselor | 619 N 500 W, Provo, UT 84601-1547 | 2017-03-13 |
| 1114469921 | Janessa Rasmussen | Community Health Worker | 619 N 500 W, Provo, UT 84601-1547 | 2016-11-09 |
| 1750823563 | Camille Brown | Community Health Worker | 619 N 500 W, Provo, UT 84601-1547 | 2016-11-09 |
| 1922540731 | Keiyana Osmond | Community Health Worker | 619 N 500 W, Provo, UT 84601-1547 | 2016-11-09 |
| 1003358813 | Haley Allmendinger | Community Health Worker | 619 N 500 W, Provo, UT 84601-1547 | 2016-11-09 |
| 1740648898 | Alexis Zimmerman | Counselor | 619 N 500 W, Provo, UT 84601-1547 | 2016-02-04 |
| 1245697978 | Carlos Ensaldo | Counselor | 619 N 500 W, Provo, UT 84601-1547 | 2016-01-26 |
| 1962869933 | Kayla Nymeyer | Counselor | 619 N 500 W, Provo, UT 84601-1547 | 2016-01-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902378417 | 1 Assist Care of Utah Valley LLC | In Home Supportive Care | 180 N University Avenue, Suite 270, Office 213, Provo, UT 84601 | 2018-12-21 |
| 1346723319 | Mp Dental LLC | Dentist | 777 N. 500 W. #204, Proud, UT 84601 | 2018-09-14 |
| 1326530601 | Madison Paige Nelson | Case Manager/Care Coordinator | 750 N Freedom Blvd., Provo, UT 84601 | 2018-06-03 |
| 1245758861 | Annette Roylance | Case Manager/Care Coordinator | 750 North Freedom Boulevard, Suite 300, Provo, UT 84601 | 2017-09-04 |
| 1912422205 | Alexandra Mcbride | Specialist/Technologist | 35 N 300 W #440, Provo, UT 84601 | 2017-08-07 |
| 1932638293 | Audrey Clara Clifton | Case Manager/Care Coordinator | 750 North Freedom Blvd., Provo, UT 84601 | 2017-06-08 |
| 1528514197 | Joseph Hyrum Lewis | Case Manager/Care Coordinator | 750 Freedom Blvd, Provo, UT 84601 | 2016-09-01 |
| 1629427620 | Walker Clements | Case Manager/Care Coordinator | 750 North Freedom Blvd, Provo, UT 84601 | 2016-06-09 |
| 1447611595 | Robert Shirley | Student in an Organized Health Care Education/Training Program | 750 North 200 West, Provo, Ut 84601., Provo, UT 84601 | 2016-03-17 |
| 1700286283 | Brelynn Downs | Student in an Organized Health Care Education/Training Program | 750 North Freedom Blvde, Provo, UT 84601 | 2014-09-03 |
| Find all providers in zip 84601 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538114889 | Daniel Clyde Cummings | Family Medicine | 694 N 1890 W Unit 44a, Provo, UT 84601-1327 | 2006-05-24 |
| 1730554734 | Blue Rock Neurological LLC | Family Medicine | 3152 N University Ave Ste 220, Provo, UT 84604-4746 | 2015-12-02 |
| 1285829309 | Lawrence W. Astle | Family Medicine | 151 S University Ave, Suite 1400, Provo, UT 84601-4427 | 2007-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467089607 | Mat Ventures | Family Medicine | 8388 S Wasatch Blvd, Cottonwood Heights, UT 84121-6075 | 2020-03-26 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1033742994 | Mobile Vivitrol | Family Medicine | 46 N Foxhill Rd, North Salt Lake, UT 84054-3027 | 2020-02-19 |
| 1518516210 | Cuicui Zhang | Family Medicine | 8686 S 1300 E # L102l104, Sandy, UT 84094-1947 | 2019-09-05 |
| 1275034084 | Southern Utah Health & Recovery | Family Medicine | 260 W Saint George Blvd Ste 202b, St George, UT 84770-3792 | 2018-02-27 |
| 1003070111 | Robert Joel Bush | Family Medicine | 74 S 360 E, American Fork, UT 84003 | 2008-07-17 |
| 1376577049 | Sean Anthony Ponce | Family Medicine | 3802 S 700 E, Salt Lake City, UT 84106-1182 | 2006-07-10 |
| 1457355869 | Charles Wesley Walton | Family Medicine | 11286 N Tamarack Dr, Highland, UT 84003-9595 | 2005-06-13 |
| 1174136113 | Amir Haskic | Family Medicine | 2870 E 3300 S, Salt Lake City, UT 84109-2821 | 2020-08-28 |
| 1689037566 | Salt Lake Behavioral Health, LLC | Family Medicine | 3802 S 700 E, Salt Lake City, UT 84106-1182 | 2016-03-30 |
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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.