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General NPI Number Information
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NPI Number | 1255568564
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Entity Type | Organization
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Legal Business Name | ASHLEY VALLEY PHYSICIAN PRACTICE LLC
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 175 N 100 W SUITE 204
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City | VERNAL
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State | UT
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Zip | 84078-2049
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Country | US
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Telephone | 435-789-1522
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Fax | 435-789-1524
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Provider Business Mailing Address
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Address Line | 330 SEVEN SPRINGS WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-5098
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Country | US
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Telephone | 615-920-7000
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | CHARLOTTE LAWRENCE
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Credential |
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Telephone | 615-920-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 6150961-1205
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License Number State | UT
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