| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1426 E 820 N, Orem, Utah |
| Authorized Official Name and Position | David Phillip Scoville (MANAGER, OWNER) |
| Authorized Official Contact | 8017091785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1426 E 820 N Orem UT 84097-5481 Ph: (801) 477-0041 | 1426 E 820 N Orem UT 84097-5481 Ph: (801) 477-0041 |
| NPI Number | 1417299827 |
|---|---|
| Provider Enumeration Date | 03/23/2013 |
| Last Update Date | 08/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417299827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 8620286-0162 (Utah) | Primary |
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