CACHE VALLEY EAR NOSE AND THROAT. – Plastic Surgery within the Head & Neck (Otolaryngology) Physician, NPI 1548303795
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CACHE VALLEY EAR NOSE AND THROAT.
1400 N 500 E
Logan, UT 843412455
Phone: (435) 719-1000
Type: Location
2380 N 400 E Ste D
North Logan, UT 843411756
Phone: (435) 753-7880
Fax: (435) 359-4507
Type: Location
2380 N 400 E
NORTH LOGAN, UT 843411749
Phone: (435) 753-7880
Fax: (435) 753-5845
Type: Mailing
169 N Gateway Dr Ste 120
Providence, UT 843329728
Phone: (435) 753-7880
Fax: (435) 359-4507
Type: Location
810 S 100 W Ste 120
Logan, UT 843215845
Phone: (435) 752-2020
Type: Location
44 N 1st E
Preston, ID 832631326
Phone: (208) 852-0137
Type: Location
164 S 5th St
Montpelier, ID 832541557
Phone: (208) 847-4359
Type: Location
2245 N 400 E STE 301
NORTH LOGAN, UT 843411892
Phone: (435) 753-7880
Fax: (435) 359-4507
Type: Mailing
2245 N 400 E
STE 301
NORTH LOGAN, UT 843411892
Phone: (435) 753-7880
Fax: (435) 359-4507
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-02-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20210719001657 | O | Clinic/Group Practice | ID | TBD |
| O20220216002175 | O | Clinic/Group Practice | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84341)
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