Healthcare Provider Details

I. General information

NPI: 1316970924
Provider Name (Legal Business Name): COPPERVIEW MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

IV. Provider business mailing address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax: 801-567-9826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL LEI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-260-1919