Healthcare Provider Details

I. General information

NPI: 1629699749
Provider Name (Legal Business Name): PHYSICIAN MANAGEMENT SERVICES OF UTAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 N NORTH COUNTY BLVD STE 200
HIGHLAND UT
84003-6012
US

IV. Provider business mailing address

3113 LAWTON RD STE 250
ORLANDO FL
32803-3517
US

V. Phone/Fax

Practice location:
  • Phone: 888-829-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRETT KENEFICK
Title or Position: PRESIDENT
Credential:
Phone: 888-829-8550