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NPI Code Detail

MEDICARE: CEDAR VALLEY FAMILY & FOOT LLC

MEDICARE: CEDAR VALLEY FAMILY & FOOT 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
1363LF0000XFamily Nurse Practitioner
2207Q00000XFamily Medicine Physician
3207RI0011XInterventional Cardiology Physician
4213ES0103XFoot & Ankle Surgery Podiatrist
5213ES0131XFoot Surgery Podiatrist

General Provider Information

NPI Number : 1649902461
Entity Type Code : Organization
Provider Name (Legal Business Name) : CEDAR VALLEY FAMILY & FOOT LLC
Provider Business Mailing Address
First Line : 3435 E PONY EXPRESS PKWY STE 140
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84005-5548
Country : US
Telephone Number : 385-388-8003
Fax Number :
Provider Business Practice Location Address
First Line : 3435 E PONY EXPRESS PKWY STE 140
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84005-5548
Country : US
Telephone Number : 801-789-2444
Fax Number : 801-789-2045
Authorized Official
Title or Position : CLINICAL ADMINISTRATOR
Name : LYNSEY NIELSEN
Credential :
Telephone Number : 385-388-8003
Provider Enumeration Date : 06/29/2022
Last Update Date : 08/22/2023

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Directions to “CEDAR VALLEY FAMILY & FOOT LLC ” Practice Location

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