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324 E 10th Ave Ste 100 Salt Lake City UT 84103-2870 | |
| (801) 408-7500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 324 E 10th Ave Ste 100, Salt Lake City, Utah |
| Authorized Official Name and Position | Mark Briesacher (SVP CHIEF PHYS EXEC/PRES-MG) |
| Authorized Official Contact | 8014423495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 27128 Salt Lake City UT 84127-0128 Ph: () - | 324 E 10th Ave Ste 100 Salt Lake City UT 84103-2870 Ph: (801) 408-7500 |
| NPI Number | 1982118485 |
|---|---|
| Provider Enumeration Date | 11/21/2017 |
| Last Update Date | 11/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982118485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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