Preston Wilson (NPI# 1952538605, PAC ID# 9234353954) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
Nation Provider ID (NPI) | 1952538605 |
PAC ID by PECOS | 9234353954 |
Professional Enrollment ID | I20160421001376 |
Full Name | Preston Wilson |
Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC |
Address |
11760 S 700 E Suite 111 Draper UT 84020-6605 |
Phone Number | 8015768855 |
Gender | M |
Medical School | ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE MID WESTERN UNIVERSITY |
Graduation Year | 2009 |
Primary Specialty | FAMILY MEDICINE |
Group Practice PAC ID | 1557443322 |
Number of Group Practice Members | 21 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
460060 | LONE PEAK HOSPITAL |
460047 | ST MARK'S HOSPITAL |
Address | Phone | Organization |
---|---|---|
11760 S 700 E, Suite 111, Draper, UT 84020-6605 | 8015768855 | MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC |
Organization Legal Name | MOUNTAINSTAR MEDICAL GROUP-ST. MARKS HOSPITAL LLC |
Physicians | 21 |
Name | Specialty | Organization | Address |
---|---|---|---|
Todd W. Furness | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 11760 S 700 E, Suite 111, Draper, UT 84020-6605 |
Todd N Schauers | Physician Assistant | Mountainstar Medical Group-st. Marks Hospital LLC | 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456 |
Philip Leonard Roberts | Internal Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009 |
Daniel Trevor Young | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Suite 300, Draper, UT 84020-5009 |
David B Jack | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Draper, UT 84020-5009 |
Amelia Maass | Nurse Practitioner | Mountainstar Medical Group-st. Marks Hospital LLC | 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456 |
Andrew Robinson | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Draper, UT 84020-5009 |
Matthew M Schellenberg | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Draper, UT 84020-5009 |
Richard Wayne Bennett | Internal Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 74 E Kimballs Ln, Draper, UT 84020-5009 |
Joni W Hougaard | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 4465 S 900 E, Suite 200, Salt Lake City, UT 84124-2456 |
Street Address |
11760 S 700 E SUITE 111 |
City | DRAPER |
State | UT |
Zip | 84020-6605 |
Name | Specialty | Organization | Address |
---|---|---|---|
Todd W. Furness | Family Medicine | Mountainstar Medical Group-st. Marks Hospital LLC | 11760 S 700 E, Suite 111, Draper, UT 84020-6605 |
Damon L Aguirre | Physical Therapy | 11760 S 700 E, Suite 211, Draper, UT 84020-6605 |
Name | Specialty | Organization | Address |
---|---|---|---|
Mark Christensen | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Matthew Broadwater-hollifield | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Azher M Merchant | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Jeffrey L Hardin | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Laurie C Raborn | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Jinghui Li | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Charles David Eller | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Jeremy Voros | Emergency Medicine | Emergency Physicians Integrated Care LLC | 11800 S State St, Lone Peak Emergency Center, Draper, UT 84020-0001 |
Jennifer F Robison | Psychologist, Clinical | 12481 S Fort St, Suite 275, Draper, UT 84020-2106 | |
Matthew D Smith | Chiropractic | Elite Performance Health Center PC | 13552 S 110 W, Suite 204, Draper, UT 84020-2403 |
Find all physicians in zip 84020 |
City | DRAPER |
Zip Code | 84020 |
Specialty | FAMILY MEDICINE |
City + Specialty | DRAPER + FAMILY MEDICINE |
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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.