Provider Demographics
NPI:1003461062
Name:WASATCH PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:WASATCH PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BRICE
Authorized Official - Last Name:HEINECKE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:801-350-1065
Mailing Address - Street 1:6807 S 3200 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1828
Mailing Address - Country:US
Mailing Address - Phone:801-350-1065
Mailing Address - Fax:
Practice Address - Street 1:451 E BISHOP FEDERAL LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2357
Practice Address - Country:US
Practice Address - Phone:801-487-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty