Healthcare Provider Details

I. General information

NPI: 1164061370
Provider Name (Legal Business Name): OAK HILL MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6781 N 2100 E
LIBERTY UT
84310-4701
US

IV. Provider business mailing address

6781 N 2100 E
LIBERTY UT
84310-4701
US

V. Phone/Fax

Practice location:
  • Phone: 435-770-4673
  • Fax: 855-965-0961
Mailing address:
  • Phone: 435-770-4673
  • Fax: 855-965-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEISA FIRTH
Title or Position: CHIEF CORPORATE OFFICER
Credential:
Phone: 435-755-5906