Healthcare Provider Details

I. General information

NPI: 1811093453
Provider Name (Legal Business Name): UTAH HEART CLINIC. LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD BUILDING B SUITE 510
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5169 S COTTONWOOD BUILDING B SUITE 510
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3500
  • Fax: 801-507-3550
Mailing address:
  • Phone: 801-507-3500
  • Fax: 801-507-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19800341
License Number StateUT

VIII. Authorized Official

Name: DR. JAMES LEE BURKE
Title or Position: M.D./PARTNER
Credential: M.D.
Phone: 801-507-3500