Healthcare Provider Details

I. General information

NPI: 1184000366
Provider Name (Legal Business Name): VISTA MEDICAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 W 9000 S STE 240
WEST JORDAN UT
84088-8864
US

IV. Provider business mailing address

1062 E BAMBERGER DR
AMERICAN FORK UT
84003-5504
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-7800
  • Fax: 801-756-7805
Mailing address:
  • Phone: 801-756-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ERIC C LEE
Title or Position: OWNER
Credential: DC
Phone: 801-756-7800