Provider Demographics
NPI:1730787458
Name:ASPEN FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:ASPEN FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-333-7633
Mailing Address - Street 1:1062 E 220 S
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-5504
Mailing Address - Country:US
Mailing Address - Phone:385-333-7633
Mailing Address - Fax:833-989-2351
Practice Address - Street 1:1062 E 220 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-5504
Practice Address - Country:US
Practice Address - Phone:385-333-7633
Practice Address - Fax:833-989-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty