| Utah Valley Tia/stroke Clinic | |
|
395 W Cougar Blvd Ste 502 Provo UT 84604-3323 | |
| (801) 357-8879 | |
| Not Available |
| Full Name | Utah Valley Tia/stroke Clinic |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 395 W Cougar Blvd Ste 502, Provo, Utah |
| Authorized Official Name and Position | Mark Briesacher (SVP - CHIEF PHY EXECUTIVE) |
| Authorized Official Contact | 8014423495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Valley Tia/stroke Clinic Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 357-8879 | Utah Valley Tia/stroke Clinic 395 W Cougar Blvd Ste 502 Provo UT 84604-3323 Ph: (801) 357-8879 |
| NPI Number | 1417241704 |
|---|---|
| Provider Enumeration Date | 06/03/2011 |
| Last Update Date | 01/14/2021 |
| Certification Date | 01/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417241704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 885211 (Utah) | Primary |
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