Healthcare Provider Details

I. General information

NPI: 1093301566
Provider Name (Legal Business Name): PREMIER FAMILY MEDICAL - VINEYARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MILL RD STE 303
VINEYARD UT
84059-5730
US

IV. Provider business mailing address

275 W 200 N
LINDON UT
84042-5009
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-1300
  • Fax: 801-225-3236
Mailing address:
  • Phone: 801-769-2560
  • Fax: 801-443-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER GUYMON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 801-769-2571