| Llc | |
|
772 E 100 N Suite #6 Payson UT 84651-2345 | |
| (801) 376-2052 | |
| (801) 465-6161 |
| Full Name | Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 772 E 100 N, Payson, Utah |
| Authorized Official Name and Position | Brian Dell Gasser (OWNER NURSE PRACTITIONER) |
| Authorized Official Contact | 8013762052 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Llc 772 E 100 N Suite #6 Payson UT 84651-2345 Ph: (801) 376-2052 | Llc 772 E 100 N Suite #6 Payson UT 84651-2345 Ph: (801) 376-2052 |
| NPI Number | 1407028590 |
|---|---|
| Provider Enumeration Date | 03/28/2008 |
| Last Update Date | 05/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407028590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2072864405 (Utah) | Primary |
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