Healthcare Provider Details

I. General information

NPI: 1104356013
Provider Name (Legal Business Name): TANNER MEMORIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 S COMMERCE DR
MURRAY UT
84107-4767
US

IV. Provider business mailing address

PO BOX 337
LAYTON UT
84041-0337
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax: 801-525-8151
Mailing address:
  • Phone: 801-773-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: KEVIN SPAINHOWER
Title or Position: BUSINESS SERVICES DIRECTOR
Credential:
Phone: 801-525-8726