ASHLEY VALLEY PHYSICIAN PRACTICE, LLC (NPI# 1740423367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740423367 |
| Entity Type | Organization |
| Organization Name | ASHLEY VALLEY PHYSICIAN PRACTICE, LLC |
| Other Organization Name | PETAR M. ILIEVSKI, MD |
| Practice Address |
150 W 100 N Vernal UT 84078-2036 |
| Practice Telephone | 4353814511 |
| Mailing Telephone | 4353814511 |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-09-04 |
| Authorized Official Name | KATHY TEAGUE (ASST VP, SECRETARY) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 7161419-8017 | UT | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Petar M. Ilievski, MD | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689008773 | Ashley Valley Physician Practice, LLC | Occupational Therapist | 1680 W Highway 40 Ste 202, Vernal, UT 84078 | 2013-08-26 |
| 1518247709 | Ashley Valley Physician Practice, LLC | Family Medicine | 409 S 200 E, Roosevelt, UT 84066-3314 | 2011-08-19 |
| 1740482025 | Ashley Valley Physician Practice, LLC | Family Medicine | 175 N. 100 W., Suite 202, Vernal, UT 84078 | 2007-05-31 |
| 1952631400 | Ashley Valley Physician Practice, LLC | Internal Medicine | 150 W 100 N, Vernal, UT 84078-2036 | 2010-01-06 |
| 1790010619 | Ashley Valley Physician Practice, LLC | Surgery | 150 W 100 N, Suite 102s, Vernal, UT 84078-2036 | 2009-10-09 |
| Street Address |
150 W 100 N |
| City | VERNAL |
| State | UT |
| Zip Code | 84078-2036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518062066 | Ashley Regional Medical Ctr Ekg Group | General Acute Care Hospital | 150 W 100 N, Vernal, UT 84078-1907 | 2006-09-13 |
| 1548874969 | Bruce A Piispanen | Occupational Therapist | 150 W 100 N, Vernal, UT 84078-2036 | 2020-09-02 |
| 1518591585 | Kara Lee Page Young | Speech-Language Pathologist | 150 W 100 N, Vernal, UT 84078-2036 | 2020-02-27 |
| 1770131591 | Sarah Elizabeth Olsen | Speech-Language Pathologist | 150 W 100 N, Vernal, UT 84078-2036 | 2019-08-27 |
| 1710533369 | Linda Mcclellan | Dietitian, Registered | 150 W 100 N, Vernal, UT 84078-2036 | 2019-08-09 |
| 1467929232 | Justin Aaron Benson | Speech-Language Pathologist | 150 W 100 N, Vernal, UT 84078-2036 | 2018-10-30 |
| 1164937645 | Ashley Valley Physician Practice LLC | Obstetrics & Gynecology | 150 W 100 N, Vernal, UT 84078-2036 | 2017-12-06 |
| 1578085320 | Jenny Lynette Henderson | Dietitian, Registered | 150 W 100 N, Vernal, UT 84078-2036 | 2017-07-13 |
| 1538512066 | Russell J Erickson | Physical Therapist | 150 W 100 N, Vernal, UT 84078-2036 | 2016-07-20 |
| 1306299839 | Justin R Watkins | Physical Therapist | 150 W 100 N, Vernal, UT 84078-2036 | 2016-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479748 | Wade Oliver Moulton | Pharmacist | 1080 W Hwy 40, Vernal, UT 84078 | 2019-10-28 |
| 1841610383 | Allegiance Addiction Recovery Center | Substance Abuse Rehabilitation Facility | 4430 N Little Valley Road, Vernal, UT 84078 | 2014-04-23 |
| 1689008773 | Ashley Valley Physician Practice, LLC | Occupational Therapist | 1680 W Highway 40 Ste 202, Vernal, UT 84078 | 2013-08-26 |
| 1528371796 | Terry L Smith | Counselor | 1140 W 500 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1619280880 | Cicile M Rios | Counselor | 1140 W 800 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1265754840 | Marjorie Elaine Gardner | Licensed Practical Nurse | 133 S 500 East, Vernal, UT 84078 | 2010-02-23 |
| 1528205853 | Robert Kirkham Jolley | Dentist | 40 West 100 North, Vernal, UT 84078 | 2009-01-08 |
| 1740482025 | Ashley Valley Physician Practice, LLC | Family Medicine | 175 N. 100 W., Suite 202, Vernal, UT 84078 | 2007-05-31 |
| 1265646459 | Ashley Valley Medical Center | Pharmacy | 151 W. 200 N., Vernal, UT 84078 | 2007-05-09 |
| 1629122692 | Brian Prentice Callahan | Dentist | 779 West Us Highway 40, Vernal, UT 84078 | 2007-01-23 |
| Find all providers in zip 84078 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945061 | Utah Urology Works LLC | Urology | 4252 S Highland Dr Ste 200, Salt Lake City, UT 84124-2690 | 2020-06-05 |
| 1619402286 | Andrew Mazzone | Urology | University of Utah Som Division of Urology, 30 North 1900 East, Salt Lake City, UT 84132-0001 | 2017-04-20 |
| 1588195135 | Laurel S. Mast | Urology | 30 N 1900 E Rm 3b427, Salt Lake City, UT 84132-0002 | 2017-03-24 |
| 1164845517 | Bruce Wayne Carlin | Urology | 375 Old Farm Ln, Coalville, UT 84017-6706 | 2014-01-21 |
| 1104182476 | Jeffrey David Sparenborg | Urology | 1157 N 300 W Ste 301, Provo, UT 84604-6124 | 2012-04-11 |
| 1588933527 | Hal H Bourne | Urology | 3250 Millcreek Dell Ln, Salt Lake City, UT 84109-3184 | 2011-12-20 |
| 1740598887 | Ihc Health Services Inc | Urology | 4403 Harrison Blvd Ste 4440, Ogden, UT 84403-3291 | 2010-09-23 |
| 1083922926 | Perry T. Walters, M.d. PC | Urology | 425 Medical Drive #112, Bountiful, UT 84010 | 2010-09-14 |
| 1447589288 | Joseph Robert Armstrong | Urology | 3291 Piute Dr, Provo, UT 84604-4849 | 2009-12-07 |
| 1851627756 | Ned Legrande Mangelson | Urology | 2691 Roxbury Cir, Salt Lake City, UT 84108-2841 | 2009-10-27 |
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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.