=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689553158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UTAH MEDICAL ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2025
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1455 S 500 W STE B
-----------------------------------------------------
City | WOODS CROSS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-8252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-340-3130
-----------------------------------------------------
Fax | 435-355-3707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 E 400 N # 332
-----------------------------------------------------
City | LOGAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84321-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-340-3130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | JUSTEN WATKINS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 385-340-3130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------