Healthcare Provider Details

I. General information

NPI: 1578985438
Provider Name (Legal Business Name): EMERE UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR SUITE 260
ST GEORGE UT
84790-4488
US

IV. Provider business mailing address

801 N 500 W SUITE 100
BOUNTIFUL UT
84010-6829
US

V. Phone/Fax

Practice location:
  • Phone: 435-757-0072
  • Fax: 435-688-0330
Mailing address:
  • Phone: 801-617-2100
  • Fax: 801-208-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: ALAN COTTLE
Title or Position: OWNER
Credential:
Phone: 801-617-2100