Healthcare Provider Details

I. General information

NPI: 1487836532
Provider Name (Legal Business Name): AMAZING MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 W ASCENSION WAY STE 225
MURRAY UT
84123
US

IV. Provider business mailing address

434 W ASCENSION WAY STE 225
MURRAY UT
84123-2790
US

V. Phone/Fax

Practice location:
  • Phone: 801-716-7008
  • Fax: 888-990-1557
Mailing address:
  • Phone: 801-716-7008
  • Fax: 888-990-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number311210-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN BLASIER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 801-716-7008