Healthcare Provider Details

I. General information

NPI: 1972012359
Provider Name (Legal Business Name): PIACITELLI FM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S STE 100
SOUTH JORDAN UT
84095-4713
US

IV. Provider business mailing address

1868 W 9800 S STE 100
SOUTH JORDAN UT
84095-4713
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-2873
  • Fax: 801-433-5734
Mailing address:
  • Phone: 801-433-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7734880-1205
License Number StateUT

VIII. Authorized Official

Name: JANICE ALLRED
Title or Position: MANAGER
Credential:
Phone: 801-285-8848