| Stacey Bank Md Pc | |
|
1151 E 3900 S Ste B299 Salt Lake City UT 84124-1216 | |
| (801) 892-0135 | |
| (801) 266-2362 |
| Full Name | Stacey Bank Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1151 E 3900 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Stacey Bank (PRESDENT) |
| Authorized Official Contact | 8018920135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Bank Md Pc 1151 E 3900 S Ste B299 Salt Lake City UT 84124-1216 Ph: (801) 892-0135 | Stacey Bank Md Pc 1151 E 3900 S Ste B299 Salt Lake City UT 84124-1216 Ph: (801) 892-0135 |
| NPI Number | 1134206311 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134206311 | NPI | - | NPPES |
| 03061975 | Other | UT | BIRTHDATE OF OWNER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 53919971205 (Utah) | Primary |
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