Provider Demographics
NPI:1386248292
Name:HILL, MATTHEW MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:HILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4038
Mailing Address - Country:US
Mailing Address - Phone:435-713-2800
Mailing Address - Fax:435-713-2835
Practice Address - Street 1:412 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4038
Practice Address - Country:US
Practice Address - Phone:435-713-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8740363AM0700X
UT12764152-1206363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12764152-1206OtherPHYSICIAN ASSISTANT LICENSE
UT12764152-8906OtherCONTROLLED SUBSTANCE LICENSE
UT2011010003OtherUTAH BEMS AEMT
AZ8740OtherPHYSICIAN ASSISTANT LICENSE
UT12764152-1206OtherPHYSICIAN ASSISTANT LICENSE
MH7533715OtherDEA - UTAH