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5169 S Cottonwood St Ste 500 Salt Lake City UT 84107-6770 | |
(801) 507-5152 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 5169 S Cottonwood St Ste 500, Salt Lake City, Utah |
Authorized Official Name and Position | Jp Valin (CHIEF CLINICAL OFFICER) |
Authorized Official Contact | 8014422000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 27128 Salt Lake City UT 84127-0128 Ph: () - | 5169 S Cottonwood St Ste 500 Salt Lake City UT 84107-6770 Ph: (801) 507-5152 |
NPI Number | 1245928282 |
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Provider Enumeration Date | 04/27/2023 |
Last Update Date | 12/20/2024 |
Identifier | Type | State | Issuer |
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1245928282 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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