MEDICARE: OUTREACH MEDICAL GROUP

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	309877-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	309877-1205	OTHER	UT	LICENSE

General Provider Information

NPI Number	:	1467974311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTREACH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3385 W 2525 N
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9228
Country	:	US
Telephone Number	:	801-644-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3385 W 2525 N
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9228
Country	:	US
Telephone Number	:	801-644-5121
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	CASEY LAWRENCE STELTER
Credential	:	MD
Telephone Number	:	801-644-5121

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	10/09/2017

Similar Medicare Providers

1912429887 — JESSE STOKES LLOYD NP
Practice Location Address:

3385 W 2525 N
PLAIN CITY, UT
84404-9228

Practice Phone: 801-644-5121
Practice Fax:

1720861891 — KATHRYN GRACE KOCH BS
Practice Location Address:

8169 MORROW WOODVILLE RD
PLEASANT PLAIN, OH
45162-9228

Practice Phone: 859-391-0771
Practice Fax:

1255497376 — SHANNETTE KEELER LCSW, PC.
Practice Location Address:

4184 W 1975 N
PLAIN CITY, UT
84404-9716

Practice Phone: 801-732-1102
Practice Fax: 801-732-1107

1578733077 — MR. JUANCARLOS SANTISTEBAN
Practice Location Address:

2404 N 3400 W # B
PLAIN CITY, UT
84404-8579

Practice Phone: 801-458-8408
Practice Fax: 801-458-8408

1376796771 — MR. JEFFERY LYNN MANNING F-NP
Practice Location Address:

1396 N 4800 W
PLAIN CITY, UT
84404-9489

Practice Phone: 801-731-7227
Practice Fax:

1760730659 — MERCURY MEDICAL LLC
Practice Location Address:

3385 W 2525 N
PLAIN CITY, UT
84404

Practice Phone: 801-644-5121
Practice Fax:

Directions to “OUTREACH MEDICAL GROUP ” 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 © 2007-2025 (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.