Healthcare Provider Details

I. General information

NPI: 1285013987
Provider Name (Legal Business Name): SPORTSMED ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N CENTER ST STE 100
LEHI UT
84043-7497
US

IV. Provider business mailing address

3401 N CENTER ST STE 100
LEHI UT
84043-7498
US

V. Phone/Fax

Practice location:
  • Phone: 801-400-7307
  • Fax:
Mailing address:
  • Phone: 801-753-7770
  • Fax: 801-753-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CURTIS A NIELSEN
Title or Position: PARTNER
Credential: D.O
Phone: 801-753-7770