Healthcare Provider Details

I. General information

NPI: 1912233172
Provider Name (Legal Business Name): EXPRESSMED URGENT CARE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MAIN ST
SPANISH FORK UT
84660-1439
US

IV. Provider business mailing address

415 N MAIN ST
SPANISH FORK UT
84660-1439
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-9700
  • Fax: 801-798-3131
Mailing address:
  • Phone: 801-798-9700
  • Fax: 801-798-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3737194405
License Number StateUT

VIII. Authorized Official

Name: KARLEN E LUTHY
Title or Position: OWNER
Credential: NP
Phone: 801-798-9700