MEDICARE: MORGAN OLIVIA MACOMBER

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	363A00000X	Physician Assistant	12288613-1206	UT

General Provider Information

NPI Number	:	1427692672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN OLIVIA MACOMBER

Provider Business Mailing Address
First Line	:	3725 W 4100 S STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-6490
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5543
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	06/24/2026

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Directions to “ MORGAN OLIVIA MACOMBER ” Practice Location

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