Provider Demographics
NPI:1639365034
Name:UTAH COUNTY MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:UTAH COUNTY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARSHAL
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-465-4896
Mailing Address - Street 1:269 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1900
Mailing Address - Country:US
Mailing Address - Phone:801-491-9883
Mailing Address - Fax:801-489-3141
Practice Address - Street 1:269 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1900
Practice Address - Country:US
Practice Address - Phone:801-491-9883
Practice Address - Fax:801-489-3141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH COUNTY MEDICAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty