MEDICARE: LYDIA JO MCGEE-RODRIGUEZ

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	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649569195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA JO MCGEE-RODRIGUEZ

Provider Business Mailing Address
First Line	:	5965 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-263-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	857 EAST 200 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-487-3276
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2017

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