Healthcare Provider Details

I. General information

NPI: 1891151668
Provider Name (Legal Business Name): ABBY N CRUME DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 320
SALT LAKE CITY UT
84124-1348
US

IV. Provider business mailing address

1250 E 3900 S STE 320
SALT LAKE CITY UT
84124-1348
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-1621
  • Fax: 801-263-1647
Mailing address:
  • Phone: 801-263-1621
  • Fax: 801-263-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number8907753-1204
License Number StateUT

VIII. Authorized Official

Name: KENT MEACHAM
Title or Position: MANAGER
Credential:
Phone: 801-476-9200