Healthcare Provider Details

I. General information

NPI: 1508649567
Provider Name (Legal Business Name): MIDTOWN COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 3750 S
SOUTH SALT LAKE UT
84115-4428
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-3315
  • Fax: 801-262-3595
Mailing address:
  • Phone: 801-334-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SONJA M LEVESQUE
Title or Position: CFO
Credential:
Phone: 801-334-1327