MEDICARE: TANNER MEMORIAL CLINIC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1538951165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANNER MEMORIAL CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-0337
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 W ANTELOPE DR
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1143
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	COREY KAMINSKA
Credential	:
Telephone Number	:	801-525-8726

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

Similar Medicare Providers

1477322063 — JORDAN ROBERT COWAN APRN
Practice Location Address:

1756 W ANTELOPE DR
LAYTON, UT
84041-1143

Practice Phone: 801-773-4840
Practice Fax:

1386118255 — ANNETTE RANAE HIMES DNP, CNM, WHNP
Practice Location Address:

1756 W ANTELOPE DR BSMT
LAYTON, UT
84041-1143

Practice Phone: 801-773-4840
Practice Fax:

1700660065 — MADELYNN WHITESIDES RANDALL FNP-C
Practice Location Address:

1756 W ANTELOPE DR
LAYTON, UT
84041-1143

Practice Phone: 801-773-4865
Practice Fax:

1427922186 — MADDISON J PETERSON
Practice Location Address:

1756 W ANTELOPE DR
LAYTON, UT
84041-1143

Practice Phone: 801-773-4840
Practice Fax:

1083180798 — DR. JACOB JUN TSUKAMOTO
Practice Location Address:

934 S MAIN ST
LAYTON, UT
84041-7135

Practice Phone: 801-336-1845
Practice Fax:

1477175461 — SARAH SOUTHERN
Practice Location Address:

934 S MAIN ST
LAYTON, UT
84041-7135

Practice Phone: 801-773-7060
Practice Fax:

Directions to “TANNER MEMORIAL CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.