Provider Demographics
NPI:1538853700
Name:MID-VALLEY MEDICAL, LLC
Entity type:Organization
Organization Name:MID-VALLEY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-566-4242
Mailing Address - Street 1:1988 W 930 N STE D
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4132
Mailing Address - Country:US
Mailing Address - Phone:801-566-4242
Mailing Address - Fax:801-987-3493
Practice Address - Street 1:5424 S COLLEGE DR STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2918
Practice Address - Country:US
Practice Address - Phone:801-566-4242
Practice Address - Fax:801-987-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy