MEDICARE: SERAPHINE BIRTH CENTER AND FAMILY CLINICS

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	261QP2300X	Primary Care Clinic/Center	52779300151	UT

General Provider Information

NPI Number	:	1740307206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERAPHINE BIRTH CENTER AND FAMILY CLINICS

Provider Business Mailing Address
First Line	:	PO BOX 71218
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-0218
Country	:	US
Telephone Number	:	801-963-6966
Fax Number	:	801-963-6366

Provider Business Practice Location Address
First Line	:	6216 S REDWOOD RD
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-6630
Country	:	US
Telephone Number	:	801-963-6966
Fax Number	:	801-963-6366

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ROBERT WENDELL GNEITING
Credential	:	APRN
Telephone Number	:	801-936-6966

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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