=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285035014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY FIRST MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 11/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 N 100 E
-----------------------------------------------------
City | SPANISH FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84660-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-504-6421
-----------------------------------------------------
Fax | 801-504-6468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1769
-----------------------------------------------------
City | SPANISH FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84660-7769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-504-6421
-----------------------------------------------------
Fax | 801-504-6468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KARL JAY BARTON
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 801-504-6421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 198637-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------