Healthcare Provider Details

I. General information

NPI: 1174465488
Provider Name (Legal Business Name): NORTHERN UTAH HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5668 BRUD DR
WEST VALLEY UT
84128-6909
US

IV. Provider business mailing address

5668 BRUD DR
WEST VALLEY UT
84128-6909
US

V. Phone/Fax

Practice location:
  • Phone: 615-344-9551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW STEVEN HASBROUCK
Title or Position: CEO
Credential:
Phone: 615-792-6123