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NPI Code Detail

MEDICARE: UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP

MEDICARE: UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1699179267
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP
Provider Business Mailing Address
First Line : PO BOX 510708
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84151-0708
Country : US
Telephone Number : 801-213-3900
Fax Number :
Provider Business Practice Location Address
First Line : 26 S MAIN ST
Second Line :
City : CENTERVILLE
State : UT
Zip : 84014-1817
Country : US
Telephone Number : 801-693-7900
Fax Number :
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : SEAN MULVIHILL
Credential : MD
Telephone Number : 801-587-6336
Provider Enumeration Date : 10/10/2014
Last Update Date : 10/10/2014

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Directions to “UNIVERSITY OF UTAH COMMUNITY PHYSICIANS GROUP ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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