MEDICARE: CHRISTINE ANDEREGG MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5856641-1205	UT
2	207P00000X	Emergency Medicine Physician	5856641-1205	UT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58566411203001	OTHER	UT	BC/BS
2	58566411206001	OTHER	UT	BC/BS
3	58566411201001	OTHER	UT	BC/BS
4	58566411204001	OTHER	UT	BC/BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	58566411200001	OTHER	UT	BC/BS
7	58566411202001	OTHER	UT	BC/BS
8	P00235569	OTHER	UT	RAILROAD
9	58566411205001	OTHER	UT	BC/BS

NPI Number	:	1720048887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ANDEREGG MD

Provider Business Mailing Address
First Line	:	144 S 500 E
Second Line	:	2ND FLOOR
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5475 S 500 E
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-6905
Country	:	US
Telephone Number	:	801-479-2111
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/21/2010

5475 S 500 E FL 1
OGDEN, UT
84405-6905

Practice Phone: 801-479-2111
Practice Fax: