MEDICARE: UPRI TAYLORSVILLE

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	174400000X	Specialist	169541-1205	UT

General Provider Information

NPI Number	:	1528327137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPRI TAYLORSVILLE

Provider Business Mailing Address
First Line	:	32 W WINCHESTER ST
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5607
Country	:	US
Telephone Number	:	801-281-0555
Fax Number	:	801-281-0444

Provider Business Practice Location Address
First Line	:	1972 W 5400 S
Second Line	:	SUITE 100
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-1459
Country	:	US
Telephone Number	:	801-281-0555
Fax Number	:	801-281-0444

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. JENNIE NGOC NGUYEN
Credential	:
Telephone Number	:	801-281-0555

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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Directions to “UPRI TAYLORSVILLE ” Practice Location

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