|
| |
|
Freeport Center Bldg D-12 Clearfield UT 84016-0010 | |
| (801) 728-1880 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | Freeport Center, Clearfield, Utah |
| Authorized Official Name and Position | Linda C Leckman (CEO INTERMOUNTAIN MEDICAL GROUP) |
| Authorized Official Contact | 8014423974 |
| 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) 728-1880 | Freeport Center Bldg D-12 Clearfield UT 84016-0010 Ph: (801) 728-1880 |
| NPI Number | 1780944025 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 05/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780944025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 3582012 (Utah) | Primary |
Midtown Community Health Center Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 22 S State Street, Clearfield, UT 84015 Phone: 801-393-5355 Fax: 801-394-4609 | |