| Pacific States Clinic | |
|
1401 E 2000 S Provo UT 84606-2072 | |
| (801) 373-6910 | |
| Not Available |
| Full Name | Pacific States Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1401 E 2000 S, Provo, 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 |
|---|---|
| Pacific States Clinic Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 373-6910 | Pacific States Clinic 1401 E 2000 S Provo UT 84606-2072 Ph: (801) 373-6910 |
| NPI Number | 1912267212 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 05/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912267212 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 8082012 (Utah) | Primary |
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