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General NPI Number Information
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NPI Number | 1003202730
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Entity Type | Organization
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Legal Business Name | PREMIER FAMILY MEDICAL - TRAVERSE MOUNTAIN
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 573 WEST SUNRISE WAY STE 102
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City | LEHI
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State | UT
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Zip | 84048-4148
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Country | US
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Telephone | 801-642-2990
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Fax | 801-642-2896
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Provider Business Mailing Address
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Address Line | 275 W 200 N
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City | LINDON
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State | UT
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Zip | 84042-5009
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Country | US
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Telephone | 801-796-1333
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Fax | 801-796-0625
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | HEATHER GUYMON
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Credential |
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Telephone | 801-769-2571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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