MEDICARE: IAA OGDEN 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1356685903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IAA OGDEN INC

Provider Business Mailing Address
First Line	:	5929 FASHION POINT DR
Second Line	:	#101
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4672
Country	:	US
Telephone Number	:	801-476-0052
Fax Number	:	801-476-0064

Provider Business Practice Location Address
First Line	:	5929 FASHION POINT DR
Second Line	:	#101
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4672
Country	:	US
Telephone Number	:	801-476-0052
Fax Number	:	801-476-0064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH ANDERSON
Credential	:
Telephone Number	:	801-476-0052

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	12/27/2012

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Directions to “IAA OGDEN INC ” Practice Location

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