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State of Utah Durable Medical Equipment US MED LLC 451 N Main Alpine Home Medical Phone Number Only Milford UT State of Utah Durable Medical Equipment US MED LLC 451 N Main Alpine Home Medical Phone Number Only Milford UT. 84751 Beaver County Phone Number Only p 800.787.6331 p 435.438.7280 p 800.686.7993 Breast Pumps United States Medical Hospital Affiliation Alpine Home Medical CCS Medical Supply - Beaver Valley Hospital Phone Number Only Phone Number Only Phone Number Only - Milford Valley Hospital p 800.686.7993 p 800.726.9811 p 877.840.8218 Home Health Agency Edgepark Care Rehab and Orthopedic Family Practice Beaver Valley Home Health Phone Number Only Products (Muscle Oakden, R W MD 1109 W 100 W p 800.321.0591 Stimulators) Beaver Medical Clinic Ste 102 Phone Number Only 1059 N 100 W Beaver UT. 84713 Cardiac Monitoring p 800.487.9644 Beaver UT. 84713 p 435.438.5481 Remote Cardiac Services p 435.438.7280 Phone Number Only DJO Global Hospice p 800.367.0300 Phone Number Only Milford Medical Clinic Beaver Valley Hospice p 800.336.6569 451 N Main 1109 W 100 W eCardio Diagnostics Milford UT. 84751 Ste 102 Phone Number Only Dynasplint Systems Inc p 435.387.2471 Beaver UT. 84713 p 888.400.3522 Phone Number Only p 435.438.5481 p 800.638.6771 Hospital Affiliation Cardiology - Beaver Valley Hospital Hospital Dahl, Charles F MD EBI LLC (Bone Stimulators) - Milford Valley Hospital Beaver Valley Hospital Revere Health Phone Number Only 1109 N 100 W 1109 N 100 W p 800.526.2579 Smith, Lance C MD Beaver UT. 84713 Beaver UT. 84713 Milford Medical Clinic p 435.438.7100 p 801.373.4366 Edgepark 1059 N 100 W Phone Number Only Beaver UT. 84713 Millford Valley Hospital Hospital Affiliation p 800.321.0591 p 435.387.2471 850 N Main St - Timpanogos Regional Hospital Milford UT. 84751 - Mountain View Hospital Empi Inc (Neuromuscular Parowan Medical Clinic p 435.387.2411 (UT) Stimulator) 450 E Clinic Way Phone Number Only Parowan UT. 84713 Laboratory Jones, Jamison C MD p 800.328.2536 p 435.477.3344 Dominion Diagnostics Revere Health Phone Number Only 1059 N 100 W KCI USA Inc (Wound Vac Milford Medical Clinic p 877.734.9600 Beaver UT. 84713 Only) 451 N Main p 435.383.9009 Phone Number Only Milford UT. 84713 LabCorp of America p 800.275.4524 p 435.438.7280 Holdings Hospital Affiliation Phone Number Only - St George Regional Hospital Orthofix Inc (Bone Growth Hospital Affiliation p 888.522.2677 Stimulators Physicians - Beaver Valley Hospital Diabetic Supplies Only) - Milford Valley Hospital Mental Health CCS Medical Phone Number Only Langford, Scott A LCSW Phone Number Only p 800.535.4492 Smith, Rhett R MD Beaver Valley Hospital p 800.726.9811 Milford Medical Clinic 1109 N 100 W Pacific Medical Inc 1059 N 100 W Beaver UT. 84713 Edgepark Phone Number Only Beaver UT. 84713 p 435.438.7183 Phone Number Only p 800.726.9180 p 435.438.7280 p 800.321.0591 Occupational Therapy RespirTech 850 N Main St Concentra Medical Centers Roche Insulin Delivery Phone Number Only Milford UT. 84751 2390 Redwood Rd Systems Inc p 800.793.1261 p 435.387.2471 West Valley City UT. 84419 Phone Number Only p 888.997.2669 p 800.280.7801 Roche Insulin Delivery Hospital Affiliation Systems Inc - Bear River Valley Hospital Orthopedic Surgery US MED LLC Phone Number Only *Robinson, Ben C Phone Number Only p 800.280.7801 Smith, Roger H MD Sevier Valley Specialty - p 800.787.6331 Milford Medical Clinic Orthopedics - Beaver Smith Nephew Inc (Muscle 1059 N 100 W 1059 N 100 W United States Medical Stimulators) Beaver UT. 84713 Beaver UT. 84713 Supply Phone Number Only p 435.387.2471 p 435.893.0800 Phone Number Only p 800.821.5700 p 877.840.8218 Hospital Affiliation - Cedar City Hospital - Sanpete Valley Hospital 1 *The PPO Agreement with this provider is expressly between the Third Party Administrator or Trust Fund and the Provider. 10/01/2021 05:46:46 **This facility may be used ONLY for specific specialty services. Members must obtain prior authorization from Payor before receiving services. All other services are available at participating hospitals with Wise Provider Networks. Physical Therapy Fujiwara, Mina BCBA Knudson, Mani BCBA Metzger, Debbie BCBA Concentra Medical Centers Utah Behavior Services Utah Behavior Services Utah Behavior Services 2390 Redwood Rd 35 Skyline Dr 35 Skyline Dr 35 Skyline Dr West Valley City UT. 84419 Ste 103 Ste 103 Ste 103 p 888.997.2669 Brigham City UT. 84302 Brigham City UT. 84302 Brigham City UT. 84302 p 801.255.5131 p 801.255.5131 p 801.255.5131 Podiatry Clark, Gary W DPM Green, Rachal BCBA,LCSW Kulow, Kacylia BCBA Nadalsky, Michelle Gary W Clark DPM Utah Behavior Services Utah Behavior Services BCBA,SSW 444 S Main St 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Milford UT. 84751 Ste 103 Ste 103 35 Skyline Dr p 888.437.3668 Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 55 N 400 E p 801.255.5131 Beaver UT. 84713 Gressmen, Casey BCBA Lambertsen, Hope BCBA p 888.437.3668 Utah Behavior Services Utah Behavior Services Oblad, Cicily BCBA 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Hospital Affiliation Ste 103 Ste 103 35 Skyline Dr - Cedar City Hospital Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Social Worker p 801.255.5131 Langford, Scott A LCSW Hanks, Julie BCBA Lee, Jennifer BCBA Beaver Valley Hospital Utah Behavior Services Utah Behavior Services Rae, Rebecca BCBA 1109 N 100 W 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Beaver UT. 84713 Ste 103 Ste 103 35 Skyline Dr p 435.438.7183 Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Box Elder County p 801.255.5131 Hoffmann, Audrey PhD Lopez, Kitrina BCBA Aba Therapy Utah Behavior Services Utah Behavior Services Renda, Cheyenne R PhD Adolphson, Lillian 35 Skyline Dr 35 Skyline Dr Utah Behavior Services BCBA-D Ste 103 Ste 103 35 Skyline Dr Utah Behavior Services Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 35 Skyline Dr p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Ste 103 p 801.255.5131 Brigham City UT. 84302 Hunt, Chelseigh BCBA Lowe, Kori BCBA p 801.255.5131 Utah Behavior Services Utah Behavior Services Rhodes, Tiffany BCBA 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Aleman, Arianna BCBA Ste 103 Ste 103 35 Skyline Dr Utah Behavior Services Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 35 Skyline Dr p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Ste 103 p 801.255.5131 Brigham City UT. 84302 Jensen, Julia P BCBA Madsen, Sara BCBA p 801.255.5131 Utah Behavior Services Utah Behavior Services Rockwell, Rene BCBA 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Christianson, Grete BCBA Ste 103 Ste 103 35 Skyline Dr Utah Behavior Services Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 35 Skyline Dr p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Ste 103 p 801.255.5131 Brigham City UT. 84302 Keller, Rebecca BCBA Maxwell, Kendra BCBA p 801.255.5131 Utah Behavior Services Utah Behavior Services Sagendorf, Emily BCBA 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Corey, Spencer BCBA Ste 103 Ste 103 35 Skyline Dr Utah Behavior Services Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 35 Skyline Dr p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Ste 103 p 801.255.5131 Brigham City UT. 84302 Kennedy, Anne BCBA McGuire, Amy BCBA p 801.255.5131 Utah Behavior Services Utah Behavior Services Sanders, Sarah BCBA 35 Skyline Dr 35 Skyline Dr Utah Behavior Services Deceuster, Rachael BCBA Ste 103 Ste 103 35 Skyline Dr Utah Behavior Services Brigham City UT. 84302 Brigham City UT. 84302 Ste 103 35 Skyline Dr p 801.255.5131 p 801.255.5131 Brigham City UT. 84302 Ste 103 p 801.255.5131 Brigham City UT. 84302 p 801.255.5131 2 *The PPO Agreement with this provider is expressly between the Third Party Administrator and the Provider. 10/01/2021 05:46:46 **This facility may be used ONLY for specific specialty services. Members must obtain prior authorization from Payor before receiving services. All other services are available at participating hospitals with Wise Provider Networks. Smith, Erica BCBA Wulfenstein, Lee BCBA Center *Otrusinik, Rudolf MD Utah Behavior Services Utah Behavior Services - Brigham City Community Bear River Valley Hospital 35 Skyline Dr 35 Skyline Dr Hospital 905 N 1000 W Ste 103 Ste 103 - Davis Hospital Tremonton UT. 84337 Brigham City UT. 84302 Brigham City UT. 84302 - Cache Valley Hospital p 435.207.4500 p 801.255.5131 p 801.255.5131 Asay, Ronald W MD Bear River Specialists Smith, Saige LPC Yang, Danielle BCBA Mountainstar Cardiology St 935 N 1000 W Utah Behavior Services Utah Behavior Services Marks Tremonton UT. 84337 35 Skyline Dr 35 Skyline Dr 970 Medical Dr p 435.207.4800 Ste 103 Ste 103 Ste 311 Brigham City UT. 84302 Brigham City UT. 84302 Brigham City UT. 84302 Hospital Affiliation p 801.255.5131 p 801.255.5131 p 801.479.0184 - Logan Regional Hospital Snow, Lauren BCBA Allergy And Immunology Hospital Affiliation *Tom, Cindy W MD Utah Behavior Services *Dickson, Scott D DO - Timpanogos Regional Hospital Bear River Valley Hospital 35 Skyline Dr Bear River Specialists - Mountain View Hospital Physicians Ste 103 935 N 1000 W (UT) 905 N 1000 W Brigham City UT.
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