Edwin M Wyman (NPI# 1730171620, PAC ID# 8628966512) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORTHOPEDIC SURGERY.
| Nation Provider ID (NPI) | 1730171620 |
| PAC ID by PECOS | 8628966512 |
| Professional Enrollment ID | I20100503000779 |
| Full Name | Edwin M Wyman |
| Organization Legal Name | SAN JUAN COUNTY HOSPITAL |
| Address |
380 W 100 N A San Juan Clinic Monticello UT 84535-1054 |
| Phone Number | 4355875054 |
| Gender | M |
| Medical School | UNIVERSITY OF COLORADO SCHOOL OF MEDICINE |
| Graduation Year | 1986 |
| Primary Specialty | ORTHOPEDIC SURGERY |
| Group Practice PAC ID | 4486541851 |
| Number of Group Practice Members | 11 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 461308 | SAN JUAN HOSPITAL |
| 061327 | SOUTHWEST MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1280 N Mildred Rd, Suite 1, Cortez, CO 81321-2212 | ||
| 364 W 100, Monticello, UT 84535-0308 | 4355872116 | SAN JUAN COUNTY HOSPITAL |
| 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 | 4355875054 | SAN JUAN COUNTY HOSPITAL |
| 380 W 100 N A, Monticello, UT 84535-1054 | 4355875054 | SAN JUAN COUNTY HOSPITAL |
| Organization Legal Name | SAN JUAN COUNTY HOSPITAL |
| Physicians | 11 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mario D La Giglia | General Surgery | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| James Walker | Physician Assistant | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Jane Sparks | Nurse Practitioner | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Kelly Marvin Jeppesen | Family Medicine | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Douglas Zeb Crofts | Family Medicine | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Nicole M Fox | Physician Assistant | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Michael Nielson | Osteopathic Manipulative Medicine | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Dashelle L Holliday | Nurse Practitioner | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| William Rainer | General Surgery | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Daniel Mower | Certified Registered Nurse Anesthetist | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Street Address |
380 W 100 N A SAN JUAN CLINIC |
| City | MONTICELLO |
| State | UT |
| Zip | 84535-1054 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James Walker | Physician Assistant | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Jane Sparks | Nurse Practitioner | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Kelly Marvin Jeppesen | Family Medicine | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Nicole M Fox | Physician Assistant | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Dashelle L Holliday | Nurse Practitioner | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| William Rainer | General Surgery | San Juan County Hospital | 380 W 100 N A, San Juan Clinic, Monticello, UT 84535-1054 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Thomas Rhett Maughan | Chiropractic | 225 S Main, Monticello, UT 84535 | |
| William L Warner | Obstetrics/gynecology | Canyon View Medical Group LLC | 380 W 100, Monticello, UT 84535 |
| Mario D La Giglia | General Surgery | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Douglas Zeb Crofts | Family Medicine | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Michael Nielson | Osteopathic Manipulative Medicine | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| Daniel Mower | Certified Registered Nurse Anesthetist | San Juan County Hospital | 364 W 100, Monticello, UT 84535-0308 |
| City | MONTICELLO |
| Zip Code | 84535 |
| Specialty | ORTHOPEDIC SURGERY |
| City + Specialty | MONTICELLO + ORTHOPEDIC SURGERY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.