MEDICARE: MS. MARY ELIZABETH HUGHES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	055-0030622	VT
2	363AM0700X	Medical Physician Assistant	14181147-1206	UT

General Provider Information

NPI Number	:	1396754008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH HUGHES PA-C

Provider Business Mailing Address
First Line	:	5734 S 1475 E STE 300
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4698
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

Provider Business Practice Location Address
First Line	:	5734 S 1475 E STE 300
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4698
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/10/2025

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