Provider Demographics
NPI:1316165947
Name:UTAH NEUROLOGICAL CLINIC, INC.
Entity type:Organization
Organization Name:UTAH NEUROLOGICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-655-4844
Mailing Address - Street 1:1055 N 300 W STE 400
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3359
Mailing Address - Country:US
Mailing Address - Phone:801-655-4844
Mailing Address - Fax:801-357-7587
Practice Address - Street 1:1055 N. 300 W. STE 400
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-357-7404
Practice Address - Fax:801-357-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty