Healthcare Provider Details

I. General information

NPI: 1619196771
Provider Name (Legal Business Name): STEP MOUNTAIN MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13352 S ROSECREST RD
HERRIMAN UT
84096-4501
US

IV. Provider business mailing address

13352 S ROSECREST RD
HERRIMAN UT
84096-4501
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-2760
  • Fax: 801-446-2762
Mailing address:
  • Phone: 801-446-2760
  • Fax: 801-446-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIMIE HOLMES
Title or Position: NP
Credential:
Phone: 801-446-2760