=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184271215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HC HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2019
-----------------------------------------------------
Last Update Date | 08/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 W MAIN ST # 3A
-----------------------------------------------------
City | HYRUM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84319-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-245-6248
-----------------------------------------------------
Fax | 435-213-9882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 W MAIN ST STE 3A
-----------------------------------------------------
City | HYRUM
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84319-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-245-6248
-----------------------------------------------------
Fax | 435-213-9882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KAMIE PRIOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 435-245-6248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------