| NPI | 1073611364 |
|---|---|
| Doing Business As | 72ND STREET MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYN THOMAS Executive Director 801-412-6920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-10-30 |