Healthcare Provider Details

I. General information

NPI: 1285038984
Provider Name (Legal Business Name): UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 LOWELL AVE
PARK CITY UT
84060-5116
US

IV. Provider business mailing address

PO BOX 510708
SALT LAKE CITY UT
84151-0708
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-7970
  • Fax:
Mailing address:
  • Phone: 801-587-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN MULVIHILL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 801-587-6336