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General NPI Number Information
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NPI Number | 1831637305
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Entity Type | Organization
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Legal Business Name | FUTURA MEDICAL CLINIC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | BLDG H11 FREEPORT CENTER
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City | CLEARFIELD
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State | UT
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Zip | 84016
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Country | US
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Telephone | 801-774-3265
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Fax |
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Provider Business Mailing Address
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Address Line | 560 S 300 E STE 275
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-3586
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Country | US
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Telephone | 801-441-1002
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | DARCE LATSIS
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Credential | CMA
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Telephone | 801-441-1002
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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 | 4227
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License Number State | UT
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