| Utah Lung Center, Llc | |
|
3584 W 9000 S West Jordan UT 84088 | |
| (801) 562-5864 | |
| (801) 568-0202 |
| Full Name | Utah Lung Center, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3584 W 9000 S, West Jordan, Utah |
| Authorized Official Name and Position | Imad S Farrukh (PRESIDENT) |
| Authorized Official Contact | 8015625864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Lung Center, Llc Po Box 150173 Ogden UT 84415 Ph: (801) 479-0601 | Utah Lung Center, Llc 3584 W 9000 S West Jordan UT 84088 Ph: (801) 562-5864 |
| NPI Number | 1093923591 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8921105081 |
|---|---|
| Medicare Enrollment ID | O20070524000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093923591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 180183-1205 (Utah) | Primary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | 180183-1205 (Utah) | Primary |
| Provider Name | Imad S Farrukh |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1851498273 PECOS PAC ID: 9931199825 Enrollment ID: I20040913000925 |
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