Healthcare Provider Details

I. General information

NPI: 1295197614
Provider Name (Legal Business Name): DOCTORS AT HOME WITH DIGNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E 340 S STE 230
AMERICAN FORK UT
84003-3493
US

IV. Provider business mailing address

765 E 340 S STE 104
AMERICAN FORK UT
84003-3347
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-4892
  • Fax:
Mailing address:
  • Phone: 385-715-6400
  • Fax: 888-271-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. BRICE NEFF WILSON II
Title or Position: CEO
Credential: M.B.A.
Phone: 801-492-4892