Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1915 W 5950 S, Roy, 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 |
---|---|
Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 387-8100 | 1915 W 5950 S Roy UT 84067-1454 Ph: (801) 387-8100 |
NPI Number | 1053441873 |
---|---|
Provider Enumeration Date | 03/07/2007 |
Last Update Date | 01/14/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053441873 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 0578 (Utah) | Secondary |
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Family Tree Preventative Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5185 S 2275 W, Roy, UT 84067 Phone: 801-698-2144 | |