Healthcare Provider Details

I. General information

NPI: 1316971179
Provider Name (Legal Business Name): TIMPANOGOS EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800N ER DEPT
OREM UT
84057
US

IV. Provider business mailing address

PO BOX 1747
OREM UT
84059-1747
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6570
  • Fax:
Mailing address:
  • Phone: 866-898-7136
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD BARLOW
Title or Position: GROUP HEAD
Credential: MD
Phone: 616-464-0024