Healthcare Provider Details

I. General information

NPI: 1629332622
Provider Name (Legal Business Name): CLINICAL RESEARCH CENTERS OF AMERICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 GREEN ST SUITE B
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5450 GREEN ST SUITE B
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-7299
  • Fax: 801-823-3082
Mailing address:
  • Phone: 801-609-7299
  • Fax: 801-823-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY BOX
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 801-609-7299