Healthcare Provider Details

I. General information

NPI: 1962417840
Provider Name (Legal Business Name): OB/GYN ASSOCIATES. L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 E 3900 S SUITE B-299
SALT LAKE CITY UT
84124-1216
US

IV. Provider business mailing address

1151 E 3900 S SUITE B-299
SALT LAKE CITY UT
84124-1216
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-6811
  • Fax: 801-268-8673
Mailing address:
  • Phone: 801-268-6811
  • Fax: 801-268-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number39454
License Number StateUT

VIII. Authorized Official

Name: AMANDA M SCHINDLER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 801-268-6811