MEDICARE: HEALOGICS SPECIALTY PHYSICIANS OF UTAH, LLC

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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1306362249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGICS SPECIALTY PHYSICIANS OF UTAH, LLC

Provider Business Mailing Address
First Line	:	5220 BELFORT RD STE 130
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6018
Country	:	US
Telephone Number	:	855-689-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:	904-446-3701
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER MORRISON
Credential	:
Telephone Number	:	855-689-5105

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	03/03/2020

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