MEDICARE: JORDAN VALLEY FAMILY HEALTH

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

General Provider Information

NPI Number	:	1437191038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN VALLEY FAMILY HEALTH

Provider Business Mailing Address
First Line	:	3570 W 9000 S
Second Line	:	SUITE #100
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-8869
Country	:	US
Telephone Number	:	801-569-1999
Fax Number	:	801-569-2001

Provider Business Practice Location Address
First Line	:	3570 W 9000 S
Second Line	:	SUITE #100
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-8869
Country	:	US
Telephone Number	:	801-569-1999
Fax Number	:	801-569-2001

Authorized Official
Title or Position	:	OWNER
Name	:	JUDITH KIRSTEIN
Credential	:	M.D.
Telephone Number	:	801-569-1999

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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Directions to “JORDAN VALLEY FAMILY HEALTH ” Practice Location

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