Healthcare Provider Details

I. General information

NPI: 1801627096
Provider Name (Legal Business Name): MOD-DOC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 N 2000 W STE 4
FARR WEST UT
84404-9811
US

IV. Provider business mailing address

1741 N 2000 W STE 4
FARR WEST UT
84404-9811
US

V. Phone/Fax

Practice location:
  • Phone: 385-470-0150
  • Fax: 385-325-0186
Mailing address:
  • Phone: 801-449-9229
  • Fax: 385-325-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFF MIDGLEY
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 801-449-9229