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General NPI Number Information
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NPI Number | 1144246984
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Entity Type | Organization
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Legal Business Name | HIDDEN VALLEY FAMILY MEDICINE INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 12176 S 1000 E
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City | DRAPER
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State | UT
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Zip | 84020-9716
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Country | US
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Telephone | 801-572-3750
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Fax | 801-572-1097
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Provider Business Mailing Address
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Address Line | 12176 S 1000 E STE 4
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City | DRAPER
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State | UT
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Zip | 84020-3221
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Country | US
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Telephone | 801-572-3750
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Fax | 801-572-1097
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DANI LASSITER
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Credential |
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Telephone | 801-572-3750
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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 | 181268-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 181191-8905
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 188509-1205
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License Number State | UT
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