MEDICARE: EXODUS HEALTHCARE NETWORK PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306952783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS HEALTHCARE NETWORK PLLC

Provider Business Mailing Address
First Line	:	3665 S 8400 W
Second Line	:	STE 110
City	:	MAGNA
State	:	UT
Zip	:	84044-4907
Country	:	US
Telephone Number	:	801-250-9638
Fax Number	:	801-250-3204

Provider Business Practice Location Address
First Line	:	3665 S 8400 W
Second Line	:	STE 110
City	:	MAGNA
State	:	UT
Zip	:	84044-4907
Country	:	US
Telephone Number	:	801-250-9638
Fax Number	:	801-250-3204

Authorized Official
Title or Position	:	MD OWNER
Name	:	BRIAN K ZEHNDER
Credential	:	MD
Telephone Number	:	801-250-9638

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/31/2012

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