CUSTOM MEDICAL SERVICES (NPI# 1669452298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669452298 |
| Entity Type | Organization |
| Organization Name | CUSTOM MEDICAL SERVICES |
| Practice Address |
Rr 3 Box 3053 Roosevelt UT 84066-9609 |
| Practice Telephone | 4357227704 |
| Mailing Telephone | 4357227704 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. STEVE EDWIN PEHRSON (PRESIDENT) |
| Authorized Official Telephone | 4357227704 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 173000000X | Legal Medicine | V09531 | UT | Other Service Providers |
| X | 207QA0000X |
Family Medicine Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians | ||
| X | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
V09531 | UT | Allopathic & Osteopathic Physicians |
| X | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
RR 3 BOX 3053 |
| City | ROOSEVELT |
| State | UT |
| Zip Code | 84066-9609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477075315 | Annemarie Rousseau | Registered Nurse | 250 West 300 North, Roosevelt, UT 84066 | 2017-07-12 |
| 1780036772 | Drew Gilley | Dentist | 375 E Lagoon St, Roosevelt, Ut 84066, Roosevelt, UT 84066 | 2016-07-01 |
| 1952758039 | Amanda Adams | Massage Therapist | 1151 East Hwy 40, Ballard, UT 84066 | 2016-05-19 |
| 1447624325 | Gregory George Page | Dentist | 209 West 200 North 71-2, Roosevelt, UT 84066 | 2015-11-16 |
| 1659785772 | Becky Ann Birch | Nurse Practitioner | 200 West 350 North, Ste 103, Roosevelt, UT 84066 | 2014-06-17 |
| 1760724280 | Novo Ranch LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3549 W 1000 North, Roosevelt, UT 84066 | 2013-03-22 |
| 1508110040 | Uintah Basin Spine and Disc Center, PC | Rehabilitation Unit | 1151 East Highway 40, Roosevelt, UT 84066 | 2012-11-06 |
| 1184918682 | Alvaro Beltran | Dentist | Ave. Lopez Mateos 171-4, Nogales, SONORA 84066 | 2011-06-02 |
| 1255638367 | Cosme Cantu | Dentist | Blvd. El Greco #45 Int. J-14, Nogales, SONORA 84066 | 2011-02-25 |
| 1740482009 | Northeastern Utah Medical Group | Durable Medical Equipment & Medical Supplies | 210 W 300 N 75 3, Roosevelt, UT 84066 | 2007-05-31 |
| Find all providers in zip 84066 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508305566 | Gracelyn Estrada | Legal Medicine | 955 S 225 E, Layton, UT 84041-4169 | 2017-02-22 |
| 1235391327 | David L. Wilkerson | Legal Medicine | 2856 Snow Cir, St George, UT 84790-7650 | 2008-06-30 |
| 1487716031 | Crossroads Family Medicine | Legal Medicine | 1305 N Commerce Dr Ste 120, Saratoga Springs, UT 84043-5309 | 2006-12-13 |
| 1871502567 | Henry Klein | Legal Medicine | 3556 W 9800 S Ste 101, South Jordan, UT 84095-3221 | 2006-08-05 |
| 1760490122 | South Summit Pediatrics. LLC | Legal Medicine | 267 E Traversepoint Drive, Draper, UT 84020 | 2006-08-03 |
| 1215964309 | Randal John Lewis | Legal Medicine | 310 E 4500 S Ste 410, Murray, UT 84107-3993 | 2006-06-26 |
| 1548208028 | William Pidwell | Legal Medicine | 750 Round Valley Dr., Suite 201, Park City, UT 84060-5127 | 2006-06-04 |
| 1033111810 | Andrew Gerald Smith | Legal Medicine | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2005-08-11 |
| 1710152228 | Brent J. Bowen, M.d.p.c. | Legal Medicine | 5250 Commerce Dr, Suite 200, Salt Lake City, UT 84107-7926 | 2008-04-25 |
| 1508067950 | Park City Healthcare, PC | Legal Medicine | 1665 Bonanza Drive, Park City, UT 84060 | 2007-05-31 |
| Find all providers with the same taxonomy | ||||
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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.