Healthcare Provider Details

I. General information

NPI: 1104122720
Provider Name (Legal Business Name): WASATHC HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 PARKSTONE DR
DRAPER UT
84020-8305
US

IV. Provider business mailing address

1135 PARKSTONE DR
DRAPER UT
84020-8305
US

V. Phone/Fax

Practice location:
  • Phone: 801-641-3686
  • Fax: 801-545-8744
Mailing address:
  • Phone: 801-641-3686
  • Fax: 801-545-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number7545378-1202
License Number StateUT

VIII. Authorized Official

Name: DR. THOMAS R FLETCHER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 801-641-3686