Healthcare Provider Details

I. General information

NPI: 1447498266
Provider Name (Legal Business Name): UTAH COUNTY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 1000 E SUITE 300
PAYSON UT
84651
US

IV. Provider business mailing address

97 PROFESSIONAL WAY SUITE 2
PAYSON UT
84651-1614
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4899
  • Fax: 801-465-3267
Mailing address:
  • Phone: 801-465-4899
  • Fax: 801-465-3267

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS CROCKETT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 801-465-4899