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NPI Code Detail

MEDICARE: WOW MEDICAL LLC

MEDICARE: WOW MEDICAL 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1356913537
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOW MEDICAL LLC
Provider Business Mailing Address
First Line : 160 W CANYON CREST RD
Second Line :
City : ALPINE
State : UT
Zip : 84004-1679
Country : US
Telephone Number : 480-359-3120
Fax Number :
Provider Business Practice Location Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 435-657-0101
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : ISAAC BUTTON
Credential :
Telephone Number : 480-359-3129
Provider Enumeration Date : 07/15/2021
Last Update Date : 07/15/2021

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Directions to “WOW MEDICAL LLC ” Practice Location

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