MEDICARE: FIRST CARE MEDICAL-FAMILY MEDICINE, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972327971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CARE MEDICAL-FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2168 W GROVE PKWY STE 200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6748
Country	:	US
Telephone Number	:	801-899-2053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 W 500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-5202
Country	:	US
Telephone Number	:	801-886-0930
Fax Number	:	801-886-0956

Authorized Official
Title or Position	:	CEO
Name	:	DR. NATE D MILLER
Credential	:	DC
Telephone Number	:	801-899-2053

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	11/14/2024

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