Healthcare Provider Details

I. General information

NPI: 1467107300
Provider Name (Legal Business Name): RED TRACTOR FAMILY MEDICINE AND PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W 12270 S
RIVERTON UT
84065-7103
US

IV. Provider business mailing address

2610 W 12270 S
RIVERTON UT
84065-7103
US

V. Phone/Fax

Practice location:
  • Phone: 801-300-3329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEORGIA ALLEN
Title or Position: OWNER
Credential: NP
Phone: 801-300-3329