MEDICARE: FIRSTMED DAVIS 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
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1962652669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRSTMED DAVIS LLC

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	801-294-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	926 W 1700 S
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-8530
Country	:	US
Telephone Number	:	801-294-6907
Fax Number	:	801-294-6917

Authorized Official
Title or Position	:	MANAGER
Name	:	FRANK S JENSEN
Credential	:
Telephone Number	:	801-294-6907

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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