=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780786525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFTER HOURS MEDICAL LLC, DBA MEDALLUS MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10464 S REDWOOD RD
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-8501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-501-0500
-----------------------------------------------------
Fax | 801-253-0696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10433 S REDWOOD RD STE 2
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-8502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-260-1919
-----------------------------------------------------
Fax | 801-260-1441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE ADMIN ASST/ CREDENTIALI
-----------------------------------------------------
Name | MRS. MONIQUE S ARAGON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-260-1919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------