MEDICARE: TOOELE CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
4	208000000X	Pediatrics Physician
5	208600000X	Surgery Physician
6	208800000X	Urology Physician
7	363A00000X	Physician Assistant
8	363LA2100X	Acute Care Nurse Practitioner
9	207Q00000X	Family Medicine Physician	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073512364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOOELE CLINIC CORP

Provider Business Mailing Address
First Line	:	PO BOX 5009
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37024-5009
Country	:	US
Telephone Number	:	615-221-1400
Fax Number	:	615-371-4600

Provider Business Practice Location Address
First Line	:	1887 AARON DR STE B
Second Line	:
City	:	TOOELE
State	:	UT
Zip	:	84074-8138
Country	:	US
Telephone Number	:	435-775-9973
Fax Number	:	435-775-9985

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/29/2025

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Directions to “TOOELE CLINIC CORP ” Practice Location

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