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NPI Code Detail

MEDICARE: NORTHERN UTAH HEALTHCARE CORPORATION

MEDICARE: NORTHERN UTAH HEALTHCARE CORPORATION
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1952233223
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN UTAH HEALTHCARE CORPORATION
Provider Business Mailing Address
First Line : 1275 E FORT UNION BLVD STE 150
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1897
Country : US
Telephone Number : 801-268-7766
Fax Number :
Provider Business Practice Location Address
First Line : 1275 E FORT UNION BLVD STE 150
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1897
Country : US
Telephone Number : 801-268-7766
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRADEN TIBBITTS
Credential :
Telephone Number : 801-465-7107
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “NORTHERN UTAH HEALTHCARE CORPORATION ” Practice Location

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