Healthcare Provider Details

I. General information

NPI: 1043299845
Provider Name (Legal Business Name): TANNER MEMORIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 W 1900 S
SYRACUSE UT
84075-9320
US

IV. Provider business mailing address

2038 W 1900 S
SYRACUSE UT
84075-9320
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax: 801-525-8151
Mailing address:
  • Phone: 801-773-4840
  • Fax: 801-525-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MEEK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 801-773-4840