Provider Demographics
NPI:1861156101
Name:WASATCH MOBILE MEDICAL
Entity type:Organization
Organization Name:WASATCH MOBILE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-420-1761
Mailing Address - Street 1:910 E 100 N STE 175
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1641
Mailing Address - Country:US
Mailing Address - Phone:385-205-3887
Mailing Address - Fax:435-268-3438
Practice Address - Street 1:910 E 100 N STE 175
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1641
Practice Address - Country:US
Practice Address - Phone:385-205-3887
Practice Address - Fax:435-268-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty