Healthcare Provider Details

I. General information

NPI: 1871654459
Provider Name (Legal Business Name): HEALTH CLINICS OF UTAH-SLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N 1950 W STE 201
SALT LAKE CITY UT
84116-3007
US

IV. Provider business mailing address

168 N 1950 W STE 201
SALT LAKE CITY UT
84116-3007
US

V. Phone/Fax

Practice location:
  • Phone: 801-715-3500
  • Fax: 801-532-1183
Mailing address:
  • Phone: 801-715-3500
  • Fax: 801-532-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE IPSEN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 801-273-6637