Healthcare Provider Details

I. General information

NPI: 1255135471
Provider Name (Legal Business Name): ALLIANCE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 W 5300 S
MURRAY UT
84123-5671
US

IV. Provider business mailing address

683 W 5300 S
MURRAY UT
84123-5671
US

V. Phone/Fax

Practice location:
  • Phone: 801-678-2263
  • Fax:
Mailing address:
  • Phone: 801-678-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: VALERIE MARTIN SR.
Title or Position: MEMBER
Credential:
Phone: 801-678-2263