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NPI Code Detail

MEDICARE: SALT LAKE BEHAVIORAL HEALTH, LLC

MEDICARE: SALT LAKE BEHAVIORAL HEALTH, 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
1207QA0401XAddiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1689037566
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALT LAKE BEHAVIORAL HEALTH, LLC
Provider Business Mailing Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number :
Provider Business Practice Location Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number :
Authorized Official
Title or Position : SR VP CFO
Name : STEVE FILTON
Credential :
Telephone Number : 610-768-3300
Provider Enumeration Date : 03/30/2016
Last Update Date : 03/30/2016

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