Healthcare Provider Details

I. General information

NPI: 1760281588
Provider Name (Legal Business Name): LEAVITT MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 W ASHTON BLVD STE 300
LEHI UT
84043-4968
US

IV. Provider business mailing address

2889 W ASHTON BLVD STE 300
LEHI UT
84043-4968
US

V. Phone/Fax

Practice location:
  • Phone: 801-960-3658
  • Fax: 844-266-9834
Mailing address:
  • Phone: 801-960-3658
  • Fax: 844-266-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KYRON NIELSEN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 801-960-3658