NPI | 1447644240 |
---|---|
Entity Type | Organization |
Authorized Contact | NOEL NELLIS Physician & Surgeon 801-479-9715 |
Organization Subpart ? | No |
Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: UT 146023-1205) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: UT 146023-1205) |
305S00000X Point of Service (Licence: UT 146023-1205) | |
Enumeration Date | 2015-03-19 |
Last Update Date | 2015-03-19 |