| NPI | 1295476083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE CLASPELL Credentialing Clerk 435-731-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine |
| 207QA0505X Family Medicine Adult Medicine | |
| 261Q00000X Clinic/Center | |
| 261QI0500X Clinic/Center Infusion Therapy | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QP3300X Clinic/Center Pain | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-11-03 |