| Live Well Center - Utah Valley | |
|
395 W Bulldog Blvd Provo UT 84604-3311 | |
| (801) 357-4141 | |
| Not Available |
| Full Name | Live Well Center - Utah Valley |
|---|---|
| Speciality | Internal Medicine - Sports Medicine |
| Location | 395 W Bulldog Blvd, Provo, Utah |
| Authorized Official Name and Position | Mark Briesacher (SVP-CHIEF PHYS EXEC/PRES - IM GROUP) |
| Authorized Official Contact | 8014423495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Center - Utah Valley Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 357-4141 | Live Well Center - Utah Valley 395 W Bulldog Blvd Provo UT 84604-3311 Ph: (801) 357-4141 |
| NPI Number | 1427515170 |
|---|---|
| Provider Enumeration Date | 02/28/2019 |
| Last Update Date | 07/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427515170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RS0010X | Internal Medicine - Sports Medicine | (* (Not Available)) | Primary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | (* (Not Available)) | Secondary |
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