Healthcare Provider Details

I. General information

NPI: 1487375473
Provider Name (Legal Business Name): NUMED CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 11/06/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 S STATE ST
OREM UT
84097-7703
US

IV. Provider business mailing address

1429 S STATE ST
OREM UT
84097-7703
US

V. Phone/Fax

Practice location:
  • Phone: 801-830-4305
  • Fax:
Mailing address:
  • Phone: 801-830-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ENKHYOUN NERGUI
Title or Position: OWNER
Credential: DNP
Phone: 801-830-4305