Healthcare Provider Details

I. General information

NPI: 1164990321
Provider Name (Legal Business Name): SALINA FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E MAIN ST
SALINA UT
84654-1335
US

IV. Provider business mailing address

PO BOX 343
SALINA UT
84654-0343
US

V. Phone/Fax

Practice location:
  • Phone: 435-529-2215
  • Fax: 435-529-2094
Mailing address:
  • Phone: 435-529-2215
  • Fax: 534-529-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARIN NUILA WATKINS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 435-650-7101