MEDICARE: TROY W BITTERS PA

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	363A00000X	Physician Assistant	325429-1206	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00129810	OTHER		PALMETTO GBA
2	32542912001001	OTHER	UT	BCBS OF UTAH

General Provider Information

NPI Number	:	1861439333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY W BITTERS PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-8898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 N 300 W
Second Line	:	#201
City	:	PROVO
State	:	UT
Zip	:	84604-6124
Country	:	US
Telephone Number	:	801-357-8898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/15/2010

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Directions to “ TROY W BITTERS PA” Practice Location

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