Healthcare Provider Details

I. General information

NPI: 1134721228
Provider Name (Legal Business Name): SENIOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 09/02/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 W 900 S STE 230
WOODS CROSS UT
84010-8195
US

IV. Provider business mailing address

598 W 900 S STE 230
WOODS CROSS UT
84010-8195
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-4040
  • Fax: 801-693-2399
Mailing address:
  • Phone: 801-397-4040
  • Fax: 801-693-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDWARD BANGERTER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-397-4101