Healthcare Provider Details

I. General information

NPI: 1629694807
Provider Name (Legal Business Name): SAMUEL FORCE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10376 S JORDAN GTWY
SOUTH JORDAN UT
84095-3954
US

IV. Provider business mailing address

10376 S JORDAN GTWY
SOUTH JORDAN UT
84095-3954
US

V. Phone/Fax

Practice location:
  • Phone: 801-816-0332
  • Fax:
Mailing address:
  • Phone: 801-816-0332
  • Fax: 801-816-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11995359-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11995359-1206
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11995359-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: