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NPI Code Detail

MEDICARE: SPECTRUM ACADEMY

MEDICARE: SPECTRUM ACADEMY
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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1457742553
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM ACADEMY
Provider Business Mailing Address
First Line : 575 CUTLER DR
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-2953
Country : US
Telephone Number : 801-936-0318
Fax Number : 801-936-0209
Provider Business Practice Location Address
First Line : 575 CUTLER DR
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-2953
Country : US
Telephone Number : 801-936-0318
Fax Number : 801-936-0209
Authorized Official
Title or Position : CFO
Name : MR. BRADLEY H. NELSON
Credential :
Telephone Number : 801-936-0318
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/26/2015

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