Healthcare Provider Details

I. General information

NPI: 1770916306
Provider Name (Legal Business Name): FREEDOM HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8899 S 700 E STE 250
SANDY UT
84070
US

IV. Provider business mailing address

8899 S 700 E STE 250
SANDY UT
84070-1810
US

V. Phone/Fax

Practice location:
  • Phone: 801-613-2711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7465201-1204
License Number StateUT

VIII. Authorized Official

Name: JEFFREY NELSON
Title or Position: OWNER
Credential: DO
Phone: 801-946-0294