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142 S 50 East Suite 102 Pob 865 Coalville UT 84017-0865 | |
(435) 336-4403 | |
(435) 336-5570 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 142 S 50 East Suite 102, Coalville, Utah |
Authorized Official Name and Position | D. Wain Allen (OWNER) |
Authorized Official Contact | 4357834385 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 865 142s 50 E Suite 102 Coalville UT 84017-0865 Ph: (435) 336-4403 | 142 S 50 East Suite 102 Pob 865 Coalville UT 84017-0865 Ph: (435) 336-4403 |
NPI Number | 1164676698 |
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Provider Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |
Identifier | Type | State | Issuer |
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1164676698 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | 1713511205 (Utah) | Primary |