MEDICARE: LIFE HEALTH MEDICAL CENTER, INC.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1659731941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HEALTH MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	2277 E ARBOR LN
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84117-5351
Country	:	US
Telephone Number	:	801-944-5900
Fax Number	:	801-944-5910

Provider Business Practice Location Address
First Line	:	1770 E FORT UNION BLVD STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2881
Country	:	US
Telephone Number	:	801-944-5900
Fax Number	:	801-944-5910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW PAUL WOOD
Credential	:
Telephone Number	:	801-450-6940

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	09/29/2016

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