Healthcare Provider Details

I. General information

NPI: 1700965308
Provider Name (Legal Business Name): HTI PHYSICIAN SERVICES OF UTAH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 NORTH STATE ST
MORGAN UT
84050-0000
US

IV. Provider business mailing address

PO BOX 1007
MORGAN UT
84050-1007
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-3426
  • Fax: 801-829-3135
Mailing address:
  • Phone: 801-829-3426
  • Fax: 801-829-3135

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: KRISTIN SUMMERS
Title or Position: AREA PRACTICE MANAGER
Credential:
Phone: 801-479-7771