Provider Demographics
NPI:1700988201
Name:DELTA FAMILY MEDICINE P.C.
Entity type:Organization
Organization Name:DELTA FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-864-3333
Mailing Address - Street 1:140 WHITE SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-8928
Mailing Address - Country:US
Mailing Address - Phone:435-864-3333
Mailing Address - Fax:435-864-2790
Practice Address - Street 1:140 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:435-864-3333
Practice Address - Fax:435-864-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center