MEDICARE: CACHE VALLEY EAR NOSE & THROAT, 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	C97276	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548303795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACHE VALLEY EAR NOSE & THROAT, PLLC

Provider Business Mailing Address
First Line	:	2245 N 400 E STE 301
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1892
Country	:	US
Telephone Number	:	435-753-7880
Fax Number	:	435-359-4507

Provider Business Practice Location Address
First Line	:	2245 N 400 E
Second Line	:	STE 301
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1892
Country	:	US
Telephone Number	:	435-753-7880
Fax Number	:	435-359-4507

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	LINSEY THALMAN
Credential	:
Telephone Number	:	435-753-7880

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	06/24/2022

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