MEDICARE: WILLOW BEND MEDICAL CENTER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1518531078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW BEND MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1809 E INDIAN WELLS LN
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8301
Country	:	US
Telephone Number	:	801-450-6940
Fax Number	:	801-944-5910

Provider Business Practice Location Address
First Line	:	1770 E FORT UNION BLVD STE 101
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2881
Country	:	US
Telephone Number	:	801-450-6940
Fax Number	:	801-944-5910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW PAUL WOOD
Credential	:	DC
Telephone Number	:	801-450-6940

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	05/18/2021

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Directions to “WILLOW BEND MEDICAL CENTER ” Practice Location

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