Healthcare Provider Details

I. General information

NPI: 1497928147
Provider Name (Legal Business Name): TOTAL CONCEPT HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N 200 W SUITE A
LOGAN UT
84321-3200
US

IV. Provider business mailing address

920 N 200 W SUITE A
LOGAN UT
84321-3200
US

V. Phone/Fax

Practice location:
  • Phone: 435-750-0366
  • Fax: 435-750-0377
Mailing address:
  • Phone: 435-750-0366
  • Fax: 435-750-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number183608-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number183608-1205
License Number StateUT

VIII. Authorized Official

Name: DR. DANEE S YOUNG
Title or Position: DOCTOR AND EXECUTIVE CHEIF
Credential: M.D.
Phone: 435-750-0366