Healthcare Provider Details

I. General information

NPI: 1669435814
Provider Name (Legal Business Name): MOUNT TIMPANOGOS WOMENS HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 W 800 N
PLEASANT GROVE UT
84062
US

IV. Provider business mailing address

1886 W 800 N
PLEASANT GROVE UT
84062
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-5288
  • Fax: 801-756-7589
Mailing address:
  • Phone: 801-756-5288
  • Fax: 801-756-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberF58967
License Number StateUT

VIII. Authorized Official

Name: EDWARD WILLIAM PARKER JR.
Title or Position: PRESIDENT OF CORP
Credential: M.D.
Phone: 801-756-5288