Provider Demographics
NPI:1134273485
Name:UTAH ARTHRITIS CLINIC PC
Entity type:Organization
Organization Name:UTAH ARTHRITIS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:STROMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-266-9300
Mailing Address - Street 1:154 MYRTLE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4833
Mailing Address - Country:US
Mailing Address - Phone:801-266-9300
Mailing Address - Fax:801-266-9305
Practice Address - Street 1:154 MYRTLE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4833
Practice Address - Country:US
Practice Address - Phone:801-266-9300
Practice Address - Fax:801-266-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184871-1205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529828575003Medicaid
UT529828575003Medicaid
UTE34507Medicare UPIN