Healthcare Provider Details

I. General information

NPI: 1609225051
Provider Name (Legal Business Name): MATTHEW R. CALL DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 W 450 S STE B
SPRINGVILLE UT
84663-2222
US

IV. Provider business mailing address

771 W 450 S STE B
SPRINGVILLE UT
84663-2222
US

V. Phone/Fax

Practice location:
  • Phone: 801-226-0737
  • Fax: 801-226-0832
Mailing address:
  • Phone: 801-226-0737
  • Fax: 801-226-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number9048767-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number191091-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MANDY HEMSLEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 801-226-0737