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NPI Code Detail

MEDICARE: WASATCH TECH IOM LLC

MEDICARE: WASATCH TECH IOM 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
12084N0400XNeurology Physician

General Provider Information

NPI Number : 1598430118
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASATCH TECH IOM LLC
Provider Business Mailing Address
First Line : 10376 S JORDAN GTWY
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-3954
Country : US
Telephone Number : 801-816-0332
Fax Number : 801-816-0331
Provider Business Practice Location Address
First Line : 10376 S JORDAN GTWY
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-3954
Country : US
Telephone Number : 801-816-0332
Fax Number : 801-816-0331
Authorized Official
Title or Position : OWNER/MBR
Name : SCOTT FROGLEY
Credential : DC
Telephone Number : 801-816-0332
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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Directions to “WASATCH TECH IOM LLC ” Practice Location

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