| NPI | 1700503182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MANGUM CEO/Physician 801-758-8735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-06-02 |