Healthcare Provider Details

I. General information

NPI: 1487683462
Provider Name (Legal Business Name): WEST JORDAN MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 W 9000 S STE 200
WEST JORDAN UT
84088-8875
US

IV. Provider business mailing address

3570 W 9000 S STE 200
WEST JORDAN UT
84088-8869
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-9211
  • Fax: 801-566-5667
Mailing address:
  • Phone: 801-566-9211
  • Fax: 801-566-5667

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA A ONEIDA
Title or Position: OWNER
Credential: M.D.
Phone: 801-567-5990