MEDICARE: MEDICRUISER, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1386893303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICRUISER, LLC

Provider Business Mailing Address
First Line	:	1850 SO. 300 WEST
Second Line	:	STE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2399
Country	:	US
Telephone Number	:	801-484-5504
Fax Number	:	801-484-5538

Provider Business Practice Location Address
First Line	:	1850 S 300 W
Second Line	:	STE A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2398
Country	:	US
Telephone Number	:	801-484-5504
Fax Number	:	801-484-5538

Authorized Official
Title or Position	:	CEO/DOCTOR
Name	:	DR. PAUL M GAHLINGER
Credential	:	M.D., PHD
Telephone Number	:	801-484-5504

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	10/21/2008

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Directions to “MEDICRUISER, LLC ” Practice Location

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