MEDICARE: FIRST CARE MEDICAL-ORTHOMED, 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
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1417823816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CARE MEDICAL-ORTHOMED, LLC

Provider Business Mailing Address
First Line	:	2168 W GROVE PKWY STE 200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6748
Country	:	US
Telephone Number	:	385-365-5053
Fax Number	:	385-365-5054

Provider Business Practice Location Address
First Line	:	4625 W LAKE PARK BLVD STE 350
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-6174
Country	:	US
Telephone Number	:	801-967-0825
Fax Number	:	385-365-5054

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATE D MILLER
Credential	:	DC
Telephone Number	:	801-899-2053

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	03/27/2026

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