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1365 W 1000 N Salt Lake City UT 84116-1654 | |
| (801) 328-5750 | |
| (801) 521-7463 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1365 W 1000 N, Salt Lake City, Utah |
| Authorized Official Name and Position | Jennifer Lyn Thomas (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8014126920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1455 W 2200 S Ste 300 West Valley City UT 84119-7219 Ph: (801) 412-6920 | 1365 W 1000 N Salt Lake City UT 84116-1654 Ph: (801) 328-5750 |
| NPI Number | 1538267828 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 5991698169 |
|---|---|
| Medicare Enrollment ID | O20100614000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538267828 | NPI | - | NPPES |
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