MEDICARE: CUSTOM MEDICAL SERVICES

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	173000000X	Legal Medicine	V09531	UT
2	207QA0505X	Adult Medicine Physician	V09531	UT
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician
4	207QA0000X	Adolescent Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1669452298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	RR 3 BOX 3053
Second Line	:
City	:	ROOSEVELT
State	:	UT
Zip	:	84066-9609
Country	:	US
Telephone Number	:	435-722-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 3 BOX 3053
Second Line	:
City	:	ROOSEVELT
State	:	UT
Zip	:	84066-9609
Country	:	US
Telephone Number	:	435-722-7704
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVE EDWIN PEHRSON
Credential	:	M.D.
Telephone Number	:	435-722-7704

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1356299457 — AMANDA HARTMAN FNP-C
Practice Location Address:

70 N MAIN ST
ROOSEVELT, UT
84066-3024

Practice Phone: 435-799-8888
Practice Fax:

1861487050 — MR. SCOTT H KOWALLIS O.D.
Practice Location Address:

165 W 200 N , 71-7
ROOSEVELT, UT
84066-2834

Practice Phone: 435-722-2981
Practice Fax: 435-722-3732

1760477731 — JON PRESTON WILSON O.D.
Practice Location Address:

165 W 200 N , 71-7
ROOSEVELT, UT
84066-2834

Practice Phone: 435-722-2981
Practice Fax: 435-722-3732

1710973052 — ROOSEVELT VISION CLINIC, PC
Practice Location Address:

165 W 200 N , 71-7
ROOSEVELT, UT
84066-2834

Practice Phone: 435-722-2981
Practice Fax: 435-722-3732

1790756815 — DR. ADAM SANFORD NIELSON MD
Practice Location Address:

250 W 300 N
ROOSEVELT, UT
84066-2351

Practice Phone: 435-722-4691
Practice Fax: 435-722-9291

1689645129 — JAMES ORVEL HOOPES PAC
Practice Location Address:

210 W 300 N # 75-3
ROOSEVELT, UT
84066-2336

Practice Phone: 435-722-6130
Practice Fax: 435-725-2033

Directions to “CUSTOM MEDICAL SERVICES ” 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 © 2007-2026 (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.