NPI | 1952505117 |
---|---|
Entity Type | Organization |
Authorized Contact | JENNIFER THOMAS Executive Director 801-412-6920 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
122300000X Dentist | |
207Q00000X Family Medicine | |
207V00000X Obstetrics & Gynecology | |
208000000X Pediatrics | |
261QM1300X Clinic/Center, Multi-Specialty | |
363A00000X Physician Assistant | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2007-06-12 |
Last Update Date | 2023-10-30 |