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General NPI Number Information
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NPI Number | 1699796706
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PRIMARY CARE SPORTS MED
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 555 FOOTHILL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-1106
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Country | US
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Telephone | 801-585-5382
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 510004
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City | SALT LAKE CITY
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State | UT
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Zip | 84151-0004
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Country | US
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Telephone | 801-587-6303
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT CHAIR
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Name | DR. MICHAEL K MAGILL
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Credential | MD
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Telephone | 801-585-5382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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