Healthcare Provider Details

I. General information

NPI: 1003001553
Provider Name (Legal Business Name): OGDEN INTERNAL MEDICINE & UROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 S 500 E STE 203
OGDEN UT
84405-7417
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-8600
  • Fax: 801-475-8686
Mailing address:
  • Phone: 615-373-7600
  • Fax: 866-346-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUIS JOSEPH
Title or Position: VP
Credential:
Phone: 615-373-7630