Healthcare Provider Details

I. General information

NPI: 1063536613
Provider Name (Legal Business Name): OGDEN WOMENS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD SUITE 4650
OGDEN UT
84403-3271
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 4650
OGDEN UT
84403-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-4400
  • Fax:
Mailing address:
  • Phone: 801-387-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LARENE SWIFT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 801-387-4412