MEDICARE: CLEARFAMILY MEDICAL DBA (MEN'STRIBAL HOUSE, LLC)

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1295685907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARFAMILY MEDICAL DBA (MEN'STRIBAL HOUSE, LLC)

Provider Business Mailing Address
First Line	:	600 S STATE ST STE 2
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1210
Country	:	US
Telephone Number	:	385-240-1232
Fax Number	:	801-515-5088

Provider Business Practice Location Address
First Line	:	600 S STATE ST STE 2
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-1210
Country	:	US
Telephone Number	:	385-240-1232
Fax Number	:	801-515-5088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SHANE COREY ERICKSEN
Credential	:	OWNER
Telephone Number	:	801-564-0411

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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