Healthcare Provider Details

I. General information

NPI: 1225358765
Provider Name (Legal Business Name): UTAH-MUA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8822 S REDWOOD RD SUITE C113
WEST JORDAN UT
84088-9336
US

IV. Provider business mailing address

32 W 6400 S SUITE 200
MURRAY UT
84107-5607
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-7246
  • Fax: 801-281-0444
Mailing address:
  • Phone: 801-281-0555
  • Fax: 801-281-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIE N NGUYEN
Title or Position: MANAGER
Credential:
Phone: 801-281-0555