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General NPI Number Information
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NPI Number | 1083642151
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Entity Type | Organization
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Legal Business Name | SMP FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 1220 E 3900 S SUITE 4A
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1377
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Country | US
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Telephone | 801-747-0922
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Fax | 801-747-0924
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Provider Business Mailing Address
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Address Line | PO BOX 932
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City | SANDY
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State | UT
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Zip | 84091-0932
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Country | US
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Telephone | 801-553-9568
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Fax | 801-553-9562
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Authorized Official
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Title or Position | OWNER
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Name | NICOLA IRENE RILEY
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Credential | M.D.
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Telephone | 801-747-0922
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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 | 56658201205
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License Number State | UT
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