Healthcare Provider Details

I. General information

NPI: 1770905705
Provider Name (Legal Business Name): EMERE UTAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 S COMMERCE DR SUITE 104
MURRAY UT
84107-4767
US

IV. Provider business mailing address

PO BOX 1468
BOUNTIFUL UT
84011-1468
US

V. Phone/Fax

Practice location:
  • Phone: 385-474-8888
  • Fax: 801-590-8123
Mailing address:
  • Phone: 801-296-2113
  • Fax: 801-296-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN COTTLE
Title or Position: CEO
Credential:
Phone: 801-617-2100