MEDICARE: ANNA I MAIR C-PA

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	363A00000X	Physician Assistant	268934-1206	UT
2	363AM0700X	Medical Physician Assistant	268934-1206	UT

General Provider Information

NPI Number	:	1508900127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA I MAIR C-PA

Provider Business Mailing Address
First Line	:	3690 S MAIN ST
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4423
Country	:	US
Telephone Number	:	801-587-2525
Fax Number	:	801-261-0503

Provider Business Practice Location Address
First Line	:	3690 S MAIN ST
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4423
Country	:	US
Telephone Number	:	801-587-2525
Fax Number	:	801-261-0503

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/13/2026

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Directions to “ ANNA I MAIR C-PA” Practice Location

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