| Integrated Care Clinic | |
|
395 W Cougar Blvd Ste 603 Provo UT 84604-3331 | |
| (801) 357-1722 | |
| Not Available |
| Full Name | Integrated Care Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 395 W Cougar Blvd Ste 603, Provo, 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 |
|---|---|
| Integrated Care Clinic Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 357-1722 | Integrated Care Clinic 395 W Cougar Blvd Ste 603 Provo UT 84604-3331 Ph: (801) 357-1722 |
| NPI Number | 1518414481 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 01/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518414481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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