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General NPI Number Information
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NPI Number | 1518531078
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Entity Type | Organization
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Legal Business Name | WILLOW BEND MEDICAL CENTER
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1770 E FORT UNION BLVD STE 101
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-2881
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Country | US
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Telephone | 801-450-6940
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Fax | 801-944-5910
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Provider Business Mailing Address
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Address Line | 1809 E INDIAN WELLS LN
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City | DRAPER
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State | UT
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Zip | 84020-8301
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Country | US
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Telephone | 801-450-6940
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Fax | 801-944-5910
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW PAUL WOOD
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Credential | DC
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Telephone | 801-450-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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