MEDICARE: MA BO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1275182487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA BO INC

Provider Business Mailing Address
First Line	:	522 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1905
Country	:	US
Telephone Number	:	801-485-5055
Fax Number	:	801-467-3296

Provider Business Practice Location Address
First Line	:	522 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1905
Country	:	US
Telephone Number	:	801-485-5055
Fax Number	:	801-467-3296

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	CAITLIN DANIELLE CACCIATORE
Credential	:
Telephone Number	:	801-485-5055

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

Similar Medicare Providers

1104258763 — SANDRA BETHEL JENSE APRN
Practice Location Address:

522 E 100 S
SALT LAKE CITY, UT
84102-1905

Practice Phone: 801-485-5055
Practice Fax:

1629616867 — SALISBURY ASSISTED LIVING, LLC
Practice Location Address:

574 E 100 S
SALT LAKE CITY, UT
84102-1905

Practice Phone: 801-485-5055
Practice Fax: 801-467-3296

1982227641 — MRS. COURTNEY HARPER PA-C
Practice Location Address:

522 E 100 S
SALT LAKE CITY, UT
84102-1905

Practice Phone: 801-485-5055
Practice Fax:

1811660764 — MRS. MERCEDES LONGSHAW MORTENSEN AGNP-C
Practice Location Address:

522 E 100 S
SALT LAKE CITY, UT
84102-1905

Practice Phone: 801-485-5055
Practice Fax:

1982333514 — KAREN FRONK AGNP, BSN, RN
Practice Location Address:

522 E 100 S
SALT LAKE CITY, UT
84102-1905

Practice Phone: 801-485-5055
Practice Fax:

1568552537 — SAMS WEST INC
Practice Location Address:

1905 S 300 W
SALT LAKE CITY, UT
84115-1806

Practice Phone: 801-478-1695
Practice Fax:

Directions to “MA BO INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.