Organization
CARESOURCE
Active
Other names
CareSource Senior Supportive Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWNTEL TANNER MA (ADMINISTRATOR)
(801) 266-7200
Entity
Organization
Contact information
Practice address
1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
(801) 266-7200
(801) 266-7004
Mailing address
1624 E 4500 S, SALT LAKE CITY, UT 84117-4212
(801) 266-7200
(801) 266-7004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5221090-1205
UT
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
5221090-1205
UT
Other
Enumeration date
04/12/2007
Last updated
09/11/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us