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General NPI Number Information
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NPI Number | 1578707352
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SPRINGS FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 954 N 200 E STE 954
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City | SPANISH FORK
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State | UT
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Zip | 84660
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Country | US
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Telephone | 801-504-6117
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Fax | 801-504-6328
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Provider Business Mailing Address
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Address Line | 954 N 200 E STE 954
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City | SPANISH FORK
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State | UT
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Zip | 84660-1247
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Country | US
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Telephone | 801-504-6117
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Fax | 801-504-6328
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDY R. LUNDELL
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Credential | D.O.
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Telephone | 801-504-6117
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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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