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MEDALLION MANOR INC
NPI 1043518145
Intermediate Care Facility, Intellectual Disabilities in Payson, UT

Active since March 14, 2011CLIA Certified · 3 labs
2192 W STATE RD, PAYSON, UT 84651(801) 375-2710(801) 377-3651 Get Directions Write a Review

NPPES record last updated: March 14, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Medallion Manor Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDALLION MANOR INC (NPI 1043518145) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Payson, Utah and active in the NPI registry since March 2011. The organization holds 3 active CLIA laboratory certificates and lists Merlin Moyes, Owner, as its authorized official.

NPPES Registry Identity

NPI1043518145
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameMEDALLION SUPPORTED LIVING-PAYSON
Location Address2192 W STATE RDPayson, UT 84651-4539
Mailing AddressPo Box 51377Provo, UT 84605-1377 · (801) 375-2710 · Fax (801) 377-3651
Phone(801) 375-2710
Fax(801) 377-3651
Organization SubpartNo
Authorized OfficialMerlin MoyesOwner · (801) 375-2710
Enumeration DateMarch 14, 2011
✔ NPI 1043518145 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in UT · 2011-SHCF-100069
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
2192 W STATE RD, Payson, UT 84651
Open in Google Maps ↗

Other Names 1

Doing Business AsMedallion Manor Inc

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 46D2197383

Medallion Supported Living Payson · Payson, UT
Active · expires Oct 22, 2026
CLIA Number46D2197383
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateOctober 23, 2024
Certificate Expiration DateOctober 22, 2026
Laboratory DirectorAaron Emory
Laboratory Phone(801) 357-2710
Laboratory LocationMedallion Supported Living Payson2192 W State Rd, Payson, UT 84651
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 46D0525403

Medallion Manor Nursing · Provo, UT
Active · expires Aug 31, 2026
CLIA Number46D0525403
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorHeather Fraughton
Laboratory Phone(801) 375-2710
Laboratory LocationMedallion Manor Nursing1701 W 600 S, Provo, UT 84601
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 46D2197363

Medallion Supported Living Lehi · Lehi, UT
Active · expires Oct 22, 2026
CLIA Number46D2197363
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateOctober 23, 2024
Certificate Expiration DateOctober 22, 2026
Laboratory DirectorKirt Kohler
Laboratory Phone(801) 375-2710
Laboratory LocationMedallion Supported Living Lehi651 E 200 S, Lehi, UT 84043
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medallion Supported Living-Payson's NPI number?

The NPI number for Medallion Supported Living-Payson is 1043518145. It was assigned to this organization in the NPPES registry on March 14, 2011. The provider is doing business as Medallion Manor Inc.

Where is Medallion Supported Living-Payson located?

Medallion Supported Living-Payson is located at 2192 W State Rd, Payson, UT 84651. The listed phone number is (801) 375-2710.

What is Medallion Supported Living-Payson's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does Medallion Supported Living-Payson hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Medallion Supported Living-Payson was last updated on March 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.