| |
222 S Main St Salt Lake City UT 84101-2174 | |
(801) 884-1801 | |
(801) 884-1807 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 222 S Main St, Salt Lake City, Utah |
Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 222 S Main St Salt Lake City UT 84101-2174 Ph: (801) 884-1801 |
NPI Number | 1790192235 |
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Provider Enumeration Date | 07/16/2014 |
Last Update Date | 08/15/2022 |
Identifier | Type | State | Issuer |
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1790192235 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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