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1624 E 4500 S Salt Lake City UT 84117-4212 | |
| (801) 266-7200 | |
| (801) 266-7004 |
| Full Name | |
|---|---|
| Speciality | Family Medicine - Hospice And Palliative Medicine |
| Location | 1624 E 4500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Shawntel Tanner (ADMINISTRATOR) |
| Authorized Official Contact | 8012667200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1624 E 4500 S Salt Lake City UT 84117-4212 Ph: (801) 266-7200 | 1624 E 4500 S Salt Lake City UT 84117-4212 Ph: (801) 266-7200 |
| NPI Number | 1124242128 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124242128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5221090-1205 (Utah) | Primary |
| 207QH0002X | Family Medicine - Hospice And Palliative Medicine | 5221090-1205 (Utah) | Primary |
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