Healthcare Provider Details

I. General information

NPI: 1417321803
Provider Name (Legal Business Name): BRIGHTON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 S 900 E
MURRAY UT
84117-5703
US

IV. Provider business mailing address

1265 E FORT UNION BLVD STE 140
COTTONWOOD HEIGHTS UT
84047-1904
US

V. Phone/Fax

Practice location:
  • Phone: 801-869-1095
  • Fax:
Mailing address:
  • Phone: 801-676-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN SAUL
Title or Position: EXECUTIVE
Credential:
Phone: 801-652-7339