| NPI | 1669683579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILDER M.D. 801-585-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: UT 6353516-1205) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: UT 6353516-8905) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |