| NPI | 1154739787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD BAILEY Executive Director 801-429-2000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: UT 138432-9922) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2025-03-27 |