Healthcare Provider Details

I. General information

NPI: 1457160376
Provider Name (Legal Business Name): MOSERTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N GATEWAY DR STE 130
PROVIDENCE UT
84332-9737
US

IV. Provider business mailing address

3105 S 225 W # A102
NIBLEY UT
84321-7067
US

V. Phone/Fax

Practice location:
  • Phone: 435-227-5371
  • Fax: 385-900-1612
Mailing address:
  • Phone: 385-222-8368
  • Fax: 385-900-1612

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

VIII. Authorized Official

Name: MR. MATTHEW MICHAEL HILL
Title or Position: CEO, OWNER
Credential: PA-C
Phone: 435-227-5371