Healthcare Provider Details

I. General information

NPI: 1225193584
Provider Name (Legal Business Name): HEALTH CLINICS OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WASHINGTON BLVD #122
OGDEN UT
84401-3122
US

IV. Provider business mailing address

2540 WASHINGTON BLVD #122
OGDEN UT
84401-3122
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-3670
  • Fax: 801-626-3646
Mailing address:
  • Phone: 801-626-3670
  • Fax: 801-626-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3762451206
License Number StateUT

VIII. Authorized Official

Name: MS. RETT HANSEN
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 801-626-3670