Providence Dermatology LLC
NPI 1568029957ActiveOrganization· Dermatology· Providence, UT
Dermatology in Providence, Utah, registered in NPPES in May 2019. The authorized official on file is Travis S. James, DO, Owner/Physician. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1568029957 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 22, 2019 |
| Last updated in NPPES | Jun 16, 2025 |
| Certified by provider | Jun 16, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (UT) |
|---|
Other Dermatology providers in Providence
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- 1538875786
- 1477818920