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General NPI Number Information
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NPI Number | 1487529764
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Entity Type | Organization
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Legal Business Name | IMPACT MEDICAL LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1776 N HIGHWAY 40, STE 101
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City | HEBER CITY
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State | UT
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Zip | 84032
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Country | US
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Telephone | 435-294-2664
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Fax | 801-274-0049
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Provider Business Mailing Address
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Address Line | 1776 N HIGHWAY 40, STE 101
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City | HEBER CITY
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State | UT
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Zip | 84032
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Country | US
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Telephone | 435-294-2664
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Fax | 801-274-0049
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BENJAMIN FOGG
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Credential | MD
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Telephone | 801-712-2535
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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