Healthcare Provider Details

I. General information

NPI: 1407947005
Provider Name (Legal Business Name): FOOTHILL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

IV. Provider business mailing address

2295 FOOTHILL DR
SALT LAKE CITY UT
84109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-3021
  • Fax: 801-485-6339
Mailing address:
  • Phone: 801-486-3021
  • Fax: 801-485-6339

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: DAN C. HENRY JR.
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 801-486-3021