Healthcare Provider Details

I. General information

NPI: 1548753866
Provider Name (Legal Business Name): PROMISE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 400 W UNIT B-8
OREM UT
84057-1909
US

IV. Provider business mailing address

159 N 400 W UNIT B-8
OREM UT
84057-1909
US

V. Phone/Fax

Practice location:
  • Phone: 385-262-4135
  • Fax: 801-899-7996
Mailing address:
  • Phone: 385-262-4135
  • Fax: 801-899-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number281795-4405
License Number StateUT

VIII. Authorized Official

Name: ANNE E VINCENT
Title or Position: OWNER
Credential: APRN
Phone: 385-262-4135