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NPI Code Detail

MEDICARE: EAGLE MOUNTAIN FAMILY MEDICINE. LLC

MEDICARE: EAGLE MOUNTAIN FAMILY MEDICINE. LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician942752821205UT

General Provider Information

NPI Number : 1316012628
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAGLE MOUNTAIN FAMILY MEDICINE. LLC
Provider Business Mailing Address
First Line : 811 NORTH 500 WEST
Second Line :
City : OREM
State : UT
Zip : 84057-7701
Country : US
Telephone Number : 801-434-7600
Fax Number : 801-434-7604
Provider Business Practice Location Address
First Line : 1305 N COMMERCE DR
Second Line : SUITE 120
City : SARATOGA SPRINGS
State : UT
Zip : 84045-5305
Country : US
Telephone Number : 801-766-2121
Fax Number : 801-768-2612
Authorized Official
Title or Position : CEO
Name : KENNETH L CRUMP
Credential : MD
Telephone Number : 801-766-2121
Provider Enumeration Date : 11/21/2006
Last Update Date : 01/26/2011

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