Healthcare Provider Details

I. General information

NPI: 1487260550
Provider Name (Legal Business Name): DOCTORS HOUSE CALLS OF UTAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 440
SALT LAKE CITY UT
84124-1349
US

IV. Provider business mailing address

1552 N CRESTMONT DR STE B
MERIDIAN ID
83642-2193
US

V. Phone/Fax

Practice location:
  • Phone: 801-791-5710
  • Fax:
Mailing address:
  • Phone: 208-957-5532
  • Fax: 208-985-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA LYNN PIKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-985-2260