MEDICARE: AUTUMN BEAR ACUPUNCTURE PLLC

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	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1942524566	OTHER	NY	PERSONAL NPI

General Provider Information

NPI Number	:	1841614625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN BEAR ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	5532 LILLEHAMMER LN STE 102
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6078
Country	:	US
Telephone Number	:	435-659-7633
Fax Number	:	971-397-0394

Provider Business Practice Location Address
First Line	:	5532 LILLEHAMMER LN STE 102
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6078
Country	:	US
Telephone Number	:	435-659-7633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AUTUMN BEAR
Credential	:
Telephone Number	:	646-415-1406

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	07/31/2025

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