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General NPI Number Information
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NPI Number | 1366022444
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Entity Type | Organization
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Legal Business Name | GREAT BASIN URGENT CARE LLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST STE 110
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City | LOGAN
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State | UT
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Zip | 84322-2600
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Country | US
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Telephone | 480-547-9256
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S MAIN ST STE 110
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City | LOGAN
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State | UT
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Zip | 84321-8504
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Country | US
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Telephone | 435-213-3046
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Fax | 435-268-6869
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTOPHER SESSIONS
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Credential |
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Telephone | 435-213-3046
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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